Features in lower-risk MDS that suggest higher-risk behavior
| MDS characteristic . | Feature associated with lesser prognosis . |
|---|---|
| Etiology of MDS | Treatment related, can behave in a heterogenous fashion |
| Fibrosis in core biopsy | Grade 2 or higher |
| Cytopenia | Symptomatic neutropenia |
| Decrease in PLTs >25% | |
| Ongoing RBC transfusion dependence | |
| Anemia or thrombocytopenia refractory to transfusions | |
| Karyotype | Clonal emergence of unfavorable karyotype |
| Somatic mutations | Multiple mutations (≥3 somatic mutations) |
| T53, RUNX1, ASXL1 mutations | |
| Absence of SF3B1 mutation (especially in MDS with ring sideroblasts) | |
| Multiple somatic mutations | |
| Inherited predisposition | Patients with known germline variant in their disease may be less likely to respond to traditional therapies and require stem cell therapy sooner |
| Treatment response | Primary treatment failure vs secondary failure |
| MDS characteristic . | Feature associated with lesser prognosis . |
|---|---|
| Etiology of MDS | Treatment related, can behave in a heterogenous fashion |
| Fibrosis in core biopsy | Grade 2 or higher |
| Cytopenia | Symptomatic neutropenia |
| Decrease in PLTs >25% | |
| Ongoing RBC transfusion dependence | |
| Anemia or thrombocytopenia refractory to transfusions | |
| Karyotype | Clonal emergence of unfavorable karyotype |
| Somatic mutations | Multiple mutations (≥3 somatic mutations) |
| T53, RUNX1, ASXL1 mutations | |
| Absence of SF3B1 mutation (especially in MDS with ring sideroblasts) | |
| Multiple somatic mutations | |
| Inherited predisposition | Patients with known germline variant in their disease may be less likely to respond to traditional therapies and require stem cell therapy sooner |
| Treatment response | Primary treatment failure vs secondary failure |