Clinical Outcomes of Decitabine Treatment for Patients With Lower-Risk Myelodysplastic Syndrome on the Basis of the International Prognostic Scoring System

Ki Sun Jung, Yoo Jin Kim, Yeo Kyeoung Kim, Sung Kyu Park, Hoon Gu Kim, Soo Jeong Kim, Jinny Park, Chul Won Choi, Young Rok Do, Inho Kim, Seonyang Park, Yeung Chul Mun, Seong Hyun Jeong, Min Kyoung Kim, Hyeon Gyu Yi, Myung Hee Chang, Su Youn Kim, Je Hwan Lee, Jun Ho Jang

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    5 Citations (Scopus)

    Abstract

    Introduction: Decitabine has shown clinical benefits in patients with intermediate (INT)-2 or high-risk myelodysplastic syndrome (MDS), determined according to the International Prognostic Scoring System (IPSS), but the benefits have not been well demonstrated in patients with lower-risk (IPSS low or INT-1) disease. Recently, it was proposed that the prognosis for patients with IPSS lower-risk disease is heterogeneous, with a substantial proportion of these patients having poor survival. Patients and Methods: This study included patients with IPSS lower-risk MDS from the DRAMA (An Observational Study for Dacogen Long-Term Treatment in Patients With Myelodysplastic Syndrome; NCT01400633) and DIVA (A Study for Dacogen Treatment in Patients With Myelodysplastic Syndrome; NCT01041846) studies, which were prospective observational studies on the efficacy and safety of decitabine treatment in patients with MDS. Using the Lower-Risk Prognostic Scoring System [LR-PSS], we classified IPSS lower-risk MDS. Patients in each LR-PSS category were divided according to overall response (OR) to decitabine treatment, and survival outcomes were compared. Results: One hundred sixteen patients were enrolled: LR-PSS category 1 (n = 12; 10.3%), category 2 (n = 56; 48.3%), and category 3 (n = 48; 41.4%). Survival outcomes differed among the 3 categories (P = .046). The overall survival according to OR showed a significant difference in total patients (P = .008) and category 3 patients (P = .003). We analyzed predictive factors for OR, but no variable was found to significantly affect OR. Conclusion: Decitabine treatment showed a survival benefit in the higher-risk group of IPSS lower-risk MDS patients who responded to treatment, and classification using the LR-PSS category was helpful for this subgroup, indicating that decitabine treatment might alter the natural course of disease in these patients. Decitabine showed a survival benefit in the higher-risk group (Lower-Risk Prognostic Scoring System [LR-PSS] category 3) of the International Prognostic Scoring System (IPSS) lower-risk (IPSS low or intermediate-1) myelodysplastic syndrome patients who responded to decitabine. Therefore, classification using the LR-PSS category was helpful for this subgroup, indicating that decitabine treatment might alter the natural course of disease in these patients.

    Original languageEnglish
    Pages (from-to)656-664
    Number of pages9
    JournalClinical Lymphoma, Myeloma and Leukemia
    Volume19
    Issue number10
    DOIs
    Publication statusPublished - 2019 Oct

    Bibliographical note

    Funding Information:
    This study was supported by Janssen Korea Ltd. Dae Young Yu and Youngdoe Kim in Janssen Korea contributed to the medical writing and statistical analysis in this study. The investigators of this study, with the exception of the authors, were as follows: Chul Soo Kim, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Young-Don Joo, Department of Hematology and Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; Yoo Hong Min, Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea; Seung Hyun Nam, Department of Hematology-Oncology, VHS Medical Center, Seoul, Korea; Sung-Hyun Kim, Division of Hematology-Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea; Eunkyung Park, Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea; Ho Young Kim and Boram Han, Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea; Ki Hyeong Lee, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea; Byung Soo Kim, Division of Hematology/Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea; Soo-Mee Bang, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea; Ho-Jin Shin, Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea; Won Sik Lee, Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, Korea; Hyun Woo Lee, Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea; Jeong-A Kim, Division of Hematology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon, Korea; Sung-Hwa Bae and Hun Mo Ryoo, Department of Hematology and Oncology, Daegu Catholic University Hospital, Daegu, Korea; Chi-Young Park, Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea; Kyu Taek Lee, Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea; Chu-Myong Seong, Department of Hematology and Oncology, School of Medicine, Ewha Womans University, Seoul, Korea; Yang Soo Kim, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea; Se Ryeon Lee, Department of Hematology/Oncology, Internal Medicine, Korea University Ansan Hospital, Ansan, Korea; Deog-Yeon Jo, Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea; Do Hyoung Lim, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea; Jae-Yong Kwak, Division of Hematology-Oncology, Chonbuk National University Medical School, Jeonju, Korea.

    Funding Information:
    This study was supported by Janssen Korea Ltd . Dae Young Yu and Youngdoe Kim in Janssen Korea contributed to the medical writing and statistical analysis in this study. The investigators of this study, with the exception of the authors, were as follows: Chul Soo Kim, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Korea; Young-Don Joo, Department of Hematology and Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; Yoo Hong Min, Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea; Seung Hyun Nam, Department of Hematology-Oncology, VHS Medical Center, Seoul, Korea; Sung-Hyun Kim, Division of Hematology-Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea; Eunkyung Park, Division of Hemato-Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea; Ho Young Kim and Boram Han, Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea; Ki Hyeong Lee, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea; Byung Soo Kim, Division of Hematology/Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea; Soo-Mee Bang, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea; Ho-Jin Shin, Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea; Won Sik Lee, Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, Korea; Hyun Woo Lee, Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea; Jeong-A Kim, Division of Hematology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, Catholic University of Korea, Suwon, Korea; Sung-Hwa Bae and Hun Mo Ryoo, Department of Hematology and Oncology, Daegu Catholic University Hospital, Daegu, Korea; Chi-Young Park, Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea; Kyu Taek Lee, Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea; Chu-Myong Seong, Department of Hematology and Oncology, School of Medicine, Ewha Womans University, Seoul, Korea; Yang Soo Kim, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea; Se Ryeon Lee, Department of Hematology/Oncology, Internal Medicine, Korea University Ansan Hospital, Ansan, Korea; Deog-Yeon Jo, Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea; Do Hyoung Lim, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea; Jae-Yong Kwak, Division of Hematology-Oncology, Chonbuk National University Medical School, Jeonju, Korea.

    Publisher Copyright:
    © 2019 Elsevier Inc.

    Keywords

    • Decitabine
    • IPSS
    • LR-PSS
    • Lower-Risk Prognostic Scoring System
    • Myelodysplastic syndrome

    ASJC Scopus subject areas

    • Hematology
    • Oncology
    • Cancer Research

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