Therapy-related myelodysplastic syndromes deserve specific diagnostic sub-classification and risk-stratification—an approach to classification of patients with t-MDS

A. Kuendgen*, M. Nomdedeu, H. Tuechler, G. Garcia-Manero, R. S. Komrokji, M. A. Sekeres, M. G. Della Porta, M. Cazzola, A. E. DeZern, G. J. Roboz, D. P. Steensma, A. A. Van de Loosdrecht, R. F. Schlenk, J. Grau, X. Calvo, S. Blum, A. Pereira, P. Valent, D. Costa, A. GiagounidisB. Xicoy, H. Döhner, U. Platzbecker, C. Pedro, M. Lübbert, I. Oiartzabal, M. Díez-Campelo, M. T. Cedena, S. Machherndl-Spandl, M. López-Pavía, C. D. Baldus, M. Martinez-de-Sola, R. Stauder, B. Merchan, A. List, C. Ganster, T. Schroeder, M. T. Voso, M. Pfeilstöcker, H. Sill, B. Hildebrandt, J. Esteve, B. Nomdedeu, F. Cobo, R. Haas, F. Sole, U. Germing, P. L. Greenberg, D. Haase, G. Sanz

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


In the current World Health Organization (WHO)-classification, therapy-related myelodysplastic syndromes (t-MDS) are categorized together with therapy-related acute myeloid leukemia (AML) and t-myelodysplastic/myeloproliferative neoplasms into one subgroup independent of morphologic or prognostic features. Analyzing data of 2087 t-MDS patients from different international MDS groups to evaluate classification and prognostication tools we found that applying the WHO classification for p-MDS successfully predicts time to transformation and survival (both p < 0.001). The results regarding carefully reviewed cytogenetic data, classifications, and prognostic scores confirmed that t-MDS are similarly heterogeneous as p-MDS and therefore deserve the same careful differentiation regarding risk. As reference, these results were compared with 4593 primary MDS (p-MDS) patients represented in the International Working Group for Prognosis in MDS database (IWG-PM). Although a less favorable clinical outcome occurred in each t-MDS subset compared with p-MDS subgroups, FAB and WHO-classification, IPSS-R, and WPSS-R separated t-MDS patients into differing risk groups effectively, indicating that all established risk factors for p-MDS maintained relevance in t-MDS, with cytogenetic features having enhanced predictive power. These data strongly argue to classify t-MDS as a separate entity distinct from other WHO-classified t-myeloid neoplasms, which would enhance treatment decisions and facilitate the inclusion of t-MDS patients into clinical studies.

Original languageEnglish
Pages (from-to)835-849
Number of pages15
Issue number3
Publication statusPublished - Mar 2021

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