Open Access

Clinical impacts of severe thrombocytopenia in the first cycle of azacitidine monotherapy and cytogenetics in patients with myelodysplastic syndrome: The Kyoto Conditional Survival Scoring System

  • Authors:
    • Yu Inoue
    • Haruya Okamoto
    • Akihiro Miyashita
    • Yuka Kawaji‑Kanayama
    • Shotaro Chinen
    • Takahiro Fujino
    • Taku Tsukamoto
    • Yuji Shimura
    • Shinsuke Mizutani
    • Hiroto Kaneko
    • Saeko Kuwahara‑Ota
    • Shin-Ichi Fuchida
    • Daichi Nishiyama
    • Koichi Hirakawa
    • Hitoji Uchiyama
    • Nobuhiko Uoshima
    • Eri Kawata
    • Junya Kuroda
  • View Affiliations

  • Published online on: December 18, 2023     https://doi.org/10.3892/ol.2023.14193
  • Article Number: 62
  • Copyright: © Inoue et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Azacitidine (AZA) has been one of the standard treatments for transplantation‑ineligible patients with myelodysplastic syndrome (MDS); however, hematological toxicities frequently cause treatment interruption in the early phase of the therapy. The present study conducted a multicenter retrospective study to investigate the prognostic impacts of various factors, including factors included in the Revised International Prognostic Scoring System (IPSS‑R) and severe cytopenia in the early phase of AZA monotherapy in 212 patients with MDS. Severe cytopenia was evaluated after the initiation of therapy by absolute neutrophil counts on the 29th day after AZA (ANC29) initiation, and red cell concentrates (RCC) and platelet concentrate (PC) transfusion units required within 28 days from the start of AZA, designated in the present study as RCC28 and PC28, respectively. The survival period was determined from the 29th day of AZA treatment to death from any cause as the conditional survival period after the first cycle of AZA (CS‑AZA1). Multivariate analysis demonstrated that severe thrombocytopenia defined by >30 units of PC28 and very poor risk cytogenetics according to IPSS‑R were independent prognostic factors for CS‑AZA1. The Kyoto Conditional Survival Scoring System was subsequently developed by incorporating severe thrombocytopenia defined by PC28 and very poor risk cytogenetics, which successfully stratified the risks of the patients in CS‑AZA1. In conclusion, extreme PC transfusion dependency during the first cycle of AZA and very poor risk cytogenetics are important prognostic factors in AZA monotherapy for MDS.
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February-2024
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Spandidos Publications style
Inoue Y, Okamoto H, Miyashita A, Kawaji‑Kanayama Y, Chinen S, Fujino T, Tsukamoto T, Shimura Y, Mizutani S, Kaneko H, Kaneko H, et al: Clinical impacts of severe thrombocytopenia in the first cycle of azacitidine monotherapy and cytogenetics in patients with myelodysplastic syndrome: The Kyoto Conditional Survival Scoring System. Oncol Lett 27: 62, 2024
APA
Inoue, Y., Okamoto, H., Miyashita, A., Kawaji‑Kanayama, Y., Chinen, S., Fujino, T. ... Kuroda, J. (2024). Clinical impacts of severe thrombocytopenia in the first cycle of azacitidine monotherapy and cytogenetics in patients with myelodysplastic syndrome: The Kyoto Conditional Survival Scoring System. Oncology Letters, 27, 62. https://doi.org/10.3892/ol.2023.14193
MLA
Inoue, Y., Okamoto, H., Miyashita, A., Kawaji‑Kanayama, Y., Chinen, S., Fujino, T., Tsukamoto, T., Shimura, Y., Mizutani, S., Kaneko, H., Kuwahara‑Ota, S., Fuchida, S., Nishiyama, D., Hirakawa, K., Uchiyama, H., Uoshima, N., Kawata, E., Kuroda, J."Clinical impacts of severe thrombocytopenia in the first cycle of azacitidine monotherapy and cytogenetics in patients with myelodysplastic syndrome: The Kyoto Conditional Survival Scoring System". Oncology Letters 27.2 (2024): 62.
Chicago
Inoue, Y., Okamoto, H., Miyashita, A., Kawaji‑Kanayama, Y., Chinen, S., Fujino, T., Tsukamoto, T., Shimura, Y., Mizutani, S., Kaneko, H., Kuwahara‑Ota, S., Fuchida, S., Nishiyama, D., Hirakawa, K., Uchiyama, H., Uoshima, N., Kawata, E., Kuroda, J."Clinical impacts of severe thrombocytopenia in the first cycle of azacitidine monotherapy and cytogenetics in patients with myelodysplastic syndrome: The Kyoto Conditional Survival Scoring System". Oncology Letters 27, no. 2 (2024): 62. https://doi.org/10.3892/ol.2023.14193