The Influence of Age and Gender on the Prognostic Impact of Karytoypic Subgroups in Myelodysplastic Syndromes - a Multicenter Analysis.
Authors: Noesslinger Thomas , Germing Ulrich , Hildebrandt Barbara , Strupp Claudia , Aivado Manuel , Haase Detlef , Schanz Julie , Wimazal Friedrich , Sperr Wolfgang , Peter Valent , Michael Lubbert , Krieger Otto , Gattermann Norbert , Giagounidis Aristoteles , Tuchler Heinz , Haas Rainer , Aul Carlo , Pfeilstocker Michael 
Published: October 2019

Abstract
In myelodysplastic syndromes (MDS) cytogenetic analysis has a major role to assess the individual risk of patients. According to the International Prognostic Scoring System (IPSS) three cytogenetic subgroups can be distinguished: favorable [-y,del(5)(q),del(20)(q)], poor [chr. 7 abnormalities, complex] and intermediate [other abnormalities]. In a multicenter analysis the prognostic impact of karyotypic patterns in a series of 1159 primary MDS patients with cytogenetic data was investigated. Aim of the presented analysis was to study the influence of age and gender on this prognostic model. Median age was 66 years, median survival 37 months, 654 patients (56,4%) were male and 505 (43,6%) female. According to the three cytogenetic riskgroups defined by the IPSS the distribution and the median survival duration were as follows: favorable 739 pts. (63,8%), 53 months; intermediate 206 pts. (17,8%), 31 months; poor 214 pts. (18,4%), 11 months. These results are concordant with other published data, especially the original publication of the IPSS. Focussing on age and gender we divided the whole patient cohort in 4 subgroups:male, female, age at time of diagnosis <66 years (579 pts.) and ≥ 66 years (580 pts.) The distribution and survival data are shown in table 1. Risk distribution was comparable among all different subgroups. Analysis of the influence of gender showed significant shorter survival for men in the low risk group, in the other two subgroups median survival duration was not significantly different in favor of the male cohort (interaction p=0.0057). In the two different age groups the younger subgroup with favorable or intermediate cytogenetics lived significantly longer, in the high risk group survival difference was not significant, but substantially the same as in the other risk groups. The observed difference in the low risk subgroup between men and women could be due to a considerable higher frequency of del(5)(q) in female patients (60 females of 83 cases). The shorter survival of the older patient cohorts with favorable or intermediate cytogenetics could be due to non-hematological comorbidity, which has more impact on survival in the lower risk subgroups, while the disease itself is the predominant factor limiting lifetime in the elderly high risk group as defined by cytogenetics.
Table 1
Female Male P (sex) <66 years ≥66 years P(age) Favorab. n(%), survival 314(62,2%) 70mo 425(65%) 40mo <0.00001 348(60,1%) 58mo 391(67,4%) 48mo 0.001 Intermed. n(%), survival 86(17%) 30mo 120(18,3%) 33mo 0.70 117(20,2%), 40mo 89(15,3%) 27mo 0.008 Poor n(%), survival 105(20,8%) 10mo 109(16,7%) 13mo 0.81 114(19,7%) 15mo 100(17,3%) 8mo 0.11 P (risk groups) <0.00001 <0.00001 <0.00001 <0.00001