Prognosis of the transformation of myelodysplastic syndromes to acute myeloid leukemia: A retrospective study

This study aimed at evaluating prognostic factors for survival and treatment response in patients with myelodysplastic syndromes (MDS) transforming to acute myeloid leukemia (AML). This retrospective study included 182 MDS patients treated at our hospital between January 2018 and January 2023, with 52 patients transforming to AML. Patients were categorized into good and poor prognosis groups based on survival beyond 12 months. Data on baseline demographics, clinical parameters at MDS diagnosis and AML transformation, treatment response, and survival outcomes were analyzed. Multivariate Cox regression was used to identify prognostic factors. Of the 52 patients who transformed into AML, 20 were in the good prognosis group and 32 in the poor prognosis group. The mean age was 64.5 ± 10.2 years, with no significant age difference between the groups (P = .15). Gender distribution was 57.7% male and 42.3% female. The good prognosis group had significantly lower Eastern Cooperative Oncology Group (ECOG) performance status scores (P = .02). At MDS diagnosis, the poor prognosis group had worse International Prognostic Scoring System scores, higher bone marrow blast percentages, poorer cytogenetic risk, and shorter transformation time (P < .05). At AML transformation, the poor prognosis group had higher white blood cell counts, bone marrow blast percentages, and TP53 mutation rates (P < .05). Multivariate analysis identified ECOG score ≥ 2 (HR = 2.91, P = .02), higher IPSS score (HR = 2.56, P = .04), RAEB-1/RAEB-2 subtypes (HR = 4.73, P = .003), higher bone marrow blast percentage (HR = 1.38, P = .02), TP53 mutation (HR = 4.92, P = .01), and high-risk cytogenetic abnormalities (HR = 6.32, P < .001) as independent poor prognosis factors. Treatment response analysis showed that patients in complete remission had significantly longer overall survival than those with partial remission or no response (P < .001). The prognosis of MDS transforming into AML is influenced by factors such as ECOG performance status, IPSS score, bone marrow blast percentage, TP53 mutations, and cytogenetic risk. These findings stress the importance of early identification of high-risk patients for treatment strategies, including intensive therapies or hematopoietic stem cell transplantation. Achieving complete remission significantly improves survival outcomes, highlighting the need for optimal early treatment.