The myelodysplastic syndromes: analysis of prognostic factors and comparison of prognostic systems in 128 Chinese patients from a single institution Wei-Li Zhao 1,2,3 , Lan Xu 1,3 , Wen Wu 1 , Hua Yan 1 , Wei Tang 1 , Jiong Hu 1 , Yu Chen 1 , Jun-Ming Li 1 , Xiao Ying Zeng 1 , Shu-Min Xiong 1 , Zhi-Xiang Shen 1 , Zhu Chen 1 , Zhen-Yi Wang 1 and Sai-Juan Chen* ,1 1 Department of Hematology, State Key Laboratory for Medical Genome Research, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Second Medical University, 197 Rui Jin Er Road, Shanghai 200025, China Introduction: Although retrospective analysis were frequently undertaken, and many prognostic systems for myelodysplastic syndromes (MDS) have been proposed worldwide, few such studies have been performed and the eectiveness of dierent scoring systems have not yet been veri®ed in independent patient populations in China. The aim of this single center study was to evaluate the prognostic factors and compare the prognostic scoring systems in Chinese patients with MDS. Materials and methods: One hundred and twenty-eight patients diagnosed as primary MDS in our Institution were studied retrospectively to identify signi®cant prognostic factors and to assess the predictive value of 11 previously described prognostic systems, including French ± American ± British (FAB) classi®cation, World Health Organization (WHO) classi®cation, Mufti, Sanz, Morra, Aul, Oguma, Toyama, Morel and international prognostic scoring system (IPSS). Results: The median age of the patients was 50 years (range 13 ± 82). The 2- and 5-year survival rate of the patients were 55.22+4.90% and 26.09+6.36% respectively, with a median survival of 31 months (range 1 ± 127 months). Fifty patients (39.1%) had progressed to acute leukemia (AL) with a median time of 8 months (range 1 ± 43 months). Major independent variables indicated by multivariate analysis were the percentage of bone marrow (BM) blast cells and complex karyotype aberrations for survival (P=0.042 and 0.042, respectively) and only the percentage of BM blast cells for AL transformation (P=0.023). All the systems except Mufti scores successfully discriminated risk groups concerning both survival and AL evolution, especially in the high risk group, ranging from 10 to 20 months and from 4 to 7 months, respectively. The FAB and WHO classi®cation, as well as Sanz, Oguma, Morel and IPSS possessed lower P value (P50.0001) than that of the rest scoring systems. Conclusion: The patients in our study were younger than these of the Western population, whereas the survival and AL transformation ratio were comparable to these previous studies. The BM blast proportion and complex chromosomal defects were highly signi®cant for predicting outcome in MDS patients. Most investigated systems eectively strati®ed patients into groups with dierent life expectancies and identi®ed a subset of patients with poor clinical outcome. The FAB, WHO classi®cation, as well as Sanz, Oguma, Morel and IPSS scoring systems were more applicable for predicting survival and leukemia progression. The Hematology Journal (2002) 3, 137 ± 144. doi:10.1038/sj.thj.6200173 Keywords: myelodysplastic syndromes; prognostic scoring systems; chronic myelomonocytic Introduction The myelodysplastic syndromes (MDS) constitute a heterogeneous group of stem cell disorders character- ized by peripheral blood cytopenia(s) in the presence of dysplastic bone marrow (BM), with features of ineective hematopoiesis. 1 The clinical course of patients is extremely variable, ranging from a chronic anemia that may span years to a rapid progression to acute leukemia (AL) within a few months. The great variability in the natural history of MDS requires a guideline for decisions on treatment. Intensive che- motherapy and bone marrow transplantation currently oer the only potentially curative treatment, but these *Correspondence: Sai-Juan Chen; E-mail: sichen@stn.sh.cn; 2 Current address: Laboratoire de Pathologie, Hopital Saint-Louis, 1, Avenue Claude Vellefaux, 75475 PARIS Cedex 10, France; Tel: 33-01-42494579 3 The ®rst two are considered equally as ®rst authors Received 15 January 2002; accepted 7 May 2002 The Hematology Journal (2002) 3, 137 ± 144 ã 2002 The European Hematology Association All rights reserved 1466 ± 4680/02 $25.00 www.nature.com/thj