Table 1

IWG criteria for stable disease, treatment failure, relapsed disease, disease progression, and transformation in MDS

  1. Stable disease

    Failure to achieve at least a PR, but with no evidence of progression for at least 2 months.

  2. Failure

    Death during treatment or disease progression characterized by worsening of cytopenias, increase in the percentage of bone marrow blasts, or progression to an MDS FAB subtype more advanced than before treatment.

  3. Relapse after CR or PR—1 or more of the following:

    • Return to pretreatment bone marrow blast percentage.

    • Decrement of 50% or greater from maximum remission/response levels in granulocytes or platelets.

    • Reduction in hemoglobin concentration by at least 20 g/L (2 g/dL) or transfusion dependence.

  4. Disease progression

    • For patients with less than 5% blasts: a 50% or more increase in blasts to more than 5% blasts.

    • For patients with 5% to 10% blasts: a 50% or more increase to more than 10% blasts.

    • For patients with 10% to 20% blasts: a 50% or more increase to more than 20% blasts.

    • For patients with 20% to 30% blasts: a 50% or more increase to more than 30% blasts. (Note: no longer applicable in 2006 IWG criteria, since the WHO in 2001 revised AML-defining blast proportion from 30% to 20%.)

    • One or more of the following: 50% or greater decrement from maximum remission/response levels in granulocytes or platelets, reduction in hemoglobin concentration by at least 20 g/L (2 g/dL), or transfusion dependence.

  5. Disease transformation

    Transformation to AML (originally 30% or more blasts; 20% or more blasts in IWG 2006 revision).

 

  1. Stable disease

    Failure to achieve at least a PR, but with no evidence of progression for at least 2 months.

  2. Failure

    Death during treatment or disease progression characterized by worsening of cytopenias, increase in the percentage of bone marrow blasts, or progression to an MDS FAB subtype more advanced than before treatment.

  3. Relapse after CR or PR—1 or more of the following:

    • Return to pretreatment bone marrow blast percentage.

    • Decrement of 50% or greater from maximum remission/response levels in granulocytes or platelets.

    • Reduction in hemoglobin concentration by at least 20 g/L (2 g/dL) or transfusion dependence.

  4. Disease progression

    • For patients with less than 5% blasts: a 50% or more increase in blasts to more than 5% blasts.

    • For patients with 5% to 10% blasts: a 50% or more increase to more than 10% blasts.

    • For patients with 10% to 20% blasts: a 50% or more increase to more than 20% blasts.

    • For patients with 20% to 30% blasts: a 50% or more increase to more than 30% blasts. (Note: no longer applicable in 2006 IWG criteria, since the WHO in 2001 revised AML-defining blast proportion from 30% to 20%.)

    • One or more of the following: 50% or greater decrement from maximum remission/response levels in granulocytes or platelets, reduction in hemoglobin concentration by at least 20 g/L (2 g/dL), or transfusion dependence.

  5. Disease transformation

    Transformation to AML (originally 30% or more blasts; 20% or more blasts in IWG 2006 revision).

 

Data are from Cheson et al.36,37 

IWG indicates International Working Group; MDS, myelodysplastic syndrome; PR, partial response; FAB, French-American-British; CR, complete response; WHO, World Health Organization; and AML, acute myeloid leukemia.

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