Prognostic factors in myelodysplastic syndromes: critical analysis of the impact of age and gender and failure to identify a very‐low‐risk group using standard mortality ratio techniques

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Abstract
We studied the prognostic value of age and gender by survival, and by standard mortality ratio (SMR) analyses, in 203 untreated patients with myelodysplastic syndromes (MDS); 57 refractory anaemia (RA), 23 refractory anaemia with ringed sideroblasts, 41 refractory anaemia with excess blasts (RAEB), 3 RAEB in transformation (RAEB‐T) and 79 chronic myelomonocytic leukaemia (CMML), aged 23–89 years (median 69, M/F 0.5), who were all karyotyped. Median survival was 36 months. Adverse prognostic factors were: high bone‐marrow blast percentage, complex karyotype, low platelet count, age>60 years, low or high WBC count, haemoglobin<10g/dl, male gender. However, the standard mortality ratio (i.e. mortality compared to that of an age‐ and sex‐adjusted population) was not different between male and female patients. Patients<60 had a higher SMR than older patients. Therefore the prognostic values of age and gender for survival in MDS patients may reflect, at least in part, a characteristic of the population. Furthermore, even in low‐risk groups defined by scoring system we were unable to define a subgroup of patients with a mortality similar to that of the normal population, especially in MDS patients aged<60.

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