1. 林建廷 April 28, 2008

2.  IPSS for MDS (FAB classification) ◦ Greenberg P et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100) Greenberg P et al  WPSS for MDS (WHO classification) ◦ Germany. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007; 25: 3503-3510. Germany

3. Free from

5.  IPSS for MDS (FAB classification) ◦ Greenberg P et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100) Greenberg P et al  WPSS for MDS (WHO classification) ◦ Germany. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007; 25: 3503-3510. Germany

7. OS Risk of AML Time-dependent WPSS

8.  Both from IPSS and WPSS, the estimated OS is about 2 yrs, and 5-yr survival probability is about 15-25%  Therefore, further treatment other than BSC is indicated. ◦ ATG/CsA ◦ Azacitidine/Decitabine ◦ Allo-SCT

9.  NIH. A simple method to predict response to immunosuppressive therapy in patients with myelodysplastic syndrome. Blood. 2003; 102: 3025-3027. NIH ◦ ATG + CsA (regardless of blast percentage)

11.  Fred Hutchinson CRC. Hematopoietic cell transplantation- specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005; 106: 2912-2919 Fred Hutchinson CRC ◦ Ablative (n=761) vs nonablative (n=294) ◦ Related (58%) vs unrelated (42%) ◦ PB(71%) vs Marrow(29%) ◦ GVHD prophylaxis with CsA/MTX(82%) or CsA/MMF(18%) ◦ GVHD tx with steroid or reinstitution of CsA ◦ Infection prophylaxis with Fluconazole, (Ceftazidime or Ciproxin), (Baktar or Dapsone), Acyclovir if sero(+)

14.  N=122 ◦ Pulmonary toxicities (24%) ◦ GVHD (11%) ◦ Infections (45%)  Infection + GVHD (18%)  Infection – GVHD (27%) ◦ Others (20%)  HCT-CI did not take into consideration including age, underlying disease and type of transplantation

15. ◦ Predict 2-yr Allo-SCT mortality (any cause)  Fred Hutchinson CRC. A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Intern Med. 2006; 144: 407-414 Fred Hutchinson CRC  n=2802  Predict survival within 2 yrs

17. Risk Groups LowCML in CP RA AA IntCML in AP CML BP then CP Acute leukemia in remission Lymphoma in remission RAEB CLL PNH HighCML in BP Acute leukemia in relapse Lymphoma in relapse RAEB-t Myeloma Solid cancer 1.Age 2.Donor type 3.Dz risk 4.Conditioning regimen 5.FEV1 6.DLCO 7.Cre 8.GPT

18. CategoryScoreProbability of Death 19-16<25% 217-2325-50% 324-3050-75% 431-44>75%

19.  Fred Hutchinson CRC. Comorbidity and disease status- based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007; 25: 4246- 4254 Fred Hutchinson CRC

20. Risk Group (by FAB classification) LowDe novo AML in CR1 RA RA-RS IntDe novo AML in CR2 or more HighAll others