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Keywords:

  • myelodysplastic syndrome;
  • thrombocytopenia;
  • cytopenia;
  • bleeding;
  • prognostic

Abstract

BACKGROUND:

Thrombocytopenia is very common in myelodysplastic syndrome (MDS); however, its clinical impact in low-risk patients remains controversial.

METHODS:

The authors analyzed the incidence and prognostic significance of thrombocytopenia at diagnosis in 2565 de novo MDS patients included in the Spanish MDS Registry.

RESULTS:

Thrombocytopenia (platelet count <100 × 109/L) was identified in 842 patients (32.8%). Severe thrombocytopenia (platelet count <30 × 109/L) was observed in 7.1% of patients and was significantly associated with a higher-risk World Health Organization subtype (P = .026) and intermediate-2/high-risk International Prognostic Scoring System (IPSS) score (P = .046). Severe thrombocytopenia was the most important prognostic factor and had negative effects on the low/intermediate-1 risk group. Median overall survival of patients with a platelet count <30 and ≥30 × 109/L was 16 months and 71 months, respectively (hazard ratio, 4.66; 95% confidence interval, 2.74-7.90; P < .0001). The negative effect of severe thrombocytopenia in low/intermediate-1 risk patients was caused by increased risk of bleeding.

CONCLUSIONS:

MDS patients with low/intermediate-1 IPSS risk score and severe thrombocytopenia should no longer be regarded as low risk, and must be considered for disease-altering approaches at diagnosis. Cancer 2011;. © 2011 American Cancer Society.