New Score Prognostic System for Patients with MDS and Intermediate IPSS-R: Novel Algorithm to Distinguish Between Low and High Risk in This Subset of Patients. Results from the Spanish Group of MDS (GESMD). Gesmdi Score

![Graphic][1] INTRODUCTION are a heterogeneous group, and it is necessary an adequate prognostic stratification in order to the best management. The new revised international prognostic scoring system (IPSS-R) has improved prognostic ability for survival and AML evolution comparing with the previous prognostic indexes. But, it is not clear the prognosis of patients included in the intermediate group, 20% of MDS, patients with a median of 3 years according to Greenberg et al, are they in the high or in the low risk category? The aims of the present study were to describe characteristics of patients included in this intermediate group of the IPSS-R in the Spanish MDS cohort and to identify which factors could have an impact on survival. A new score prognostic system (GESMDi score) in order to a better stratification should be proposed in this subset of patients that will be useful for determine the best therapeutic approach for them.METHODS : All patients were included in the GESMD, diagnosed of Primary MSD and Intermediate IPSS-R. The Statistical analyzes were performed using SPSS version 21, Cox models and Kaplan-Meier curves were used to demonstrate clinical outcomes. Regarding the new score proposed, GESMDi score, modeling of prognostic risk was based on multivariate analysis of survival time. Cox model for survival was built to derive the relative weights within the score.RESULTS: Data from 957 patients of 69 centers of GESMD were evaluated. Their median age was 73.9 years (p25/p75 66-80), 61.6% males (N=590), and median follow-up 21,4 months (p25-p75 de 11-41). Regarding WHO 2001 classification: 31% were RAEB-1, 21% CMML, 18% RCMD, 14% RAEB-2, 3% RCMD-RS, 3.1% RARS, 2.5% RA, 2% 5q-syndrome, 2% AML, 1% unclassified. Median hemoglobin at diagnosis was 9.8 g/dL (p25/p75:8.3-11.6), median bone marrow (BM) blasts 6% (p25/p75:3-8) and median platelet count 99x109/L (p25/p75:66-180). According to IPSS, 5% of patients were classified as low risk, 78% as intermediate-1, 16% as intermediate-2 and 1% as high risk. Cytogenetic were very good in 2% of patients, good in 76%, intermediate in 17%, poor in 5% and in 1% very poor. IPSS-R score classified patients in 3 different groups, with a punctuation of≤ 3.5 (35.6%), u003e3.5 and ≤ 4 (35.8%) andu003e 4 and ≤ 4.5 (28.5%).Median was 30.1 months, the estimated 1-year and 2-y were 79.2% and 57.8%, respectively. In the univariate analysis for older age (u003e74y, p 500 ng/ml, p=0.002), and higher IPSS-R score (u003e3.5 and ≤ 4 and u003e4 and ≤ 4.5, p=0.023 and p=0.004, figure 1) had a deleterious impact on survival. In the multivariate analysis, only age, Hb level, PB blast, ferritine level and IPSS-R value retained statistical significant impact on (table 1a). In the multivariate analysis, Hazard ratio, a new score system (GESMDi score) was established for all patients. Patients with adverse features were added points in order to stratify the risk of death: age 500 ng/ml and/or IPSS-R of u003e3.5 (1 point), table 1a.The GESMDi score was performed in 685 patients with all data available and 7 groups of patients were defined with different median (p 30 months) and high risk patients (u003c30 months). Patients with scores between 0-3 (70.6% patients, me 41.1, 95CI 34.4-47.7) were in the low risk definition while patients with scores between 4-6 (29.3% patients, me 17.5 mo, 95CI 13.4-21.5) were classified as high risk patients (pu003c 0.0001, 2).CONCLUSIONS: GESMDi score, a proposed prognostic score system from patients with intermediate IPSS-R, allow us to establish a better prognosis stratification in this heterogeneous MDS population. Treatment and management should be better established for those patients nowadays according to this novel stratification.![Table 1][2] Table 1 a) Univariate and multivariate analysis for among patients with Intermediate IPSS-R b) according to the GESMDi score proposed ![Figure 1][2] Figure 1 OS according to IPSS-R value in the intermediate group (≤3.5, ≤4 and ≤4.5)![Figure 2][2] Figure 2 OS according the GESMDi score proposed in the intermediate IPSS-R group: low and high risk patients (n=685)Disclosures Del Canizo: Celgene: Membership on an entityu0027s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Astex: Membership on an entityu0027s Board of Directors or advisory committees; janssen: Research Funding; Novartis: Membership on an entityu0027s Board of Directors or advisory committees, Research Funding, Speakers Diez Campelo: Novartis: Membership on an entityu0027s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Astex: Membership on an entityu0027s Board of Directors or advisory committees; Janssen: Research Funding; celgene: Membership on an entityu0027s Board of Directors or advisory committees, Research Funding, Speakers Bureau. [1]: /embed/inline-graphic-2.gif [2]: pending:yes