prognosis

Last reviewed 01/2018

Myelodysplasias are ultimately fatal. Death results from bleeding, infection, transformation to AML, or transfusion related iron-overload. Remission occurs in less than half of cases and typically, is short lived.

Risks of leukaemic transformation are:

• 5-10% in refractory anaemia and in refractory anaemia with ringed sideroblasts
• 40-50% in refractory anaemia with excess blasts
• 100% in refractory anaemia with excess blasts in transformation

Median survival figures after diagnosis are:

• 3-5 years in refractory anaemia and in refractory anaemia with ringed sideroblasts
• 1-2 years in refractory anaemia with excess blasts and in chronic myelomonocytic leukaemia
• less than 1 year in refractory anaemia with excess blasts in transformation

Poor prognostic factors for survival:

• more than 5% blast cells in the marrow
• very low blood counts
• patients with abnormalities of chromosome 5 or 7 have a particularly poor prognosis. Certain subgroups, such as patients with an interstitial deletion of 5q associated with refractory anaemia and thrombocytosis, can expect a relatively good outcome (2)

Reference:

1. Brandwein (1992). Myelodysplasia. Med. Int. 97.
2. Jacobs RH, Cornbleet MA, Vardiman JW, et al. Prognostic implications of morphology and karyotype in myelodysplastic syndromes. Blood 1986; 67:1765–72