Latest news with #riskStratification
Medscape
2 days ago
- Health
- Medscape
Fast Five Quiz: Low-Risk Myelodysplastic Syndrome
Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematopoietic stem cell disorders, each with varying levels of prognosis. Risk stratification is an important component of MDS; however, even lower-risk variants require a nuanced approach to management, and certain factors can further affect patient risk after diagnosis. What do you know about low-risk MDS? Check your knowledge with this quick quiz. Among the gene mutations identified that can influence the prognosis in MDS, SF3B1 mutation is strongly associated with favorable clinical outcomes. Other mutations such as such as TP53 , ASXL1 , EZH2 , ETV6 , and RUNX1 typically lead to poorer clinical outcomes. The National Comprehensive Care Network (NCCN) notes that combining analysis of these mutations in MDS with International Prognostic Scoring System (IPSS) can improve risk stratification beyond the strengths of the IPSS alone, which is standard practice in some treatment centers. Learn more about cytogenic studies for MDS. Data have shown that hypocellular bone marrow is one of several factors that predict good response to IST in patients with lower-risk MDS. The NCCN specifically recommends IST in select patients, generally those 'aged ≤60 years and with ≤5% marrow blasts, or those with hypocellular marrows, PNH clone positivity, or STAT-3 mutant cytotoxic T-cell clones.' Other factors associated with predicted benefit from IST include presence of dysplasia, young age (< 60 years), presence of HLA DR15, female sex, absence of ring sideroblasts, presence of trisomy 8, and relatively short duration of transfusion need. Learn more about hypocellular marrow in MDS. A study of patients with very low- and low-risk MDS found that mutations in three genes, IDH1 , IDH2 , and NPM1 , are more common among those patients with direct transformation to AML. NPM1 mutations are the most frequently-seen mutation in AML and are found in approximately 30%-35% of cases among adults. Mutations in ASXL1 , CBL , and TP53 were found to be associated with progression to higher-risk MDS but not with transformation to AML. Learn more about cytogenetics in MDS. According to a review published in JAMA , the median survival time for patients with low and very low risk MDS is 5.3 years and 8.8 years, respectively. This is consistent with other recent data. Collected data from the same JAMA review indicated that the median age for MDS diagnosis is approximately 70 years and is more common in males; chemotherapy and radiation therapy exposure are also reported significant risk factors. Further, the IPSS, revised-IPSS, and WHO classification-based prognostic scoring system are the most frequently used scoring systems for MDS risk. Learn more about MDS risk staging. Due to longer survival, patients with low-risk MDS might be given multiple red blood cell transfusions as part of their management (which could potentially lead to iron overload). To decrease iron overload, the NCCN recommends consideration of daily iron chelation with subcutaneous deferoxamine or oral deferasirox after > 20-30 transfusions. This approach is especially recommended for patients with lower-risk MDS or those who are potential candidates for transplantation. Learn more about iron chelation in MDS. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
19-05-2025
- Health
- Medscape
New High-Risk TNBC Subgroup Identified
New data support integrating tumor-infiltrating lymphocyte levels with nodal status to improve risk stratification in women with triple-negative breast cancer (TNBC) and pathological complete response (pCR) following neoadjuvant treatment. Specifically, patients with lower levels of tumor-infiltrating lymphocytes had a higher risk for relapse and worse overall survival than those with higher levels, said Davide Massa, MD, medical oncologist, University of Padua, Padua, Italy. 'For every 5% increase in [tumor-infiltrating lymphocytes], we saw a 10% reduction in the risk of distant relapse-free survival and an 11% reduction in the risk of death,' he reported in an oral presentation at the ESMO Breast Cancer 2025 meeting. And when combining tumor-infiltrating lymphocytes and nodal status, 'we could identify a previously unrecognized high-risk subgroup — patients with low tumor-infiltrating lymphocytes and positive nodal involvement,' Massa noted. These data may help guide post-neoadjuvant strategies for patients otherwise considered to have favorable long-term outcomes, he added. Refining Risk Stratification In TNBC, pCR after neoadjuvant treatment is associated with favorable outcomes, but a subset of patients remains at risk for relapse. Massa and his colleagues wanted to find out if they could identify these patients. Stromal tumor-infiltrating lymphocytes in TNBC are a strong independent prognostic biomarker associated with improved outcomes, yet their role in risk stratification within the pCR subgroup has been underexplored. The retrospective study included 1532 patients with stage I-III TNBC who received neoadjuvant therapy between 2000 and 2023 at 12 European centers. Of these patients, 733 (48%) had a pCR. Tumor-infiltrating lymphocyte levels, assessed in treatment-naive biopsies, were available for 613 patients with a pCR (84%), which comprised the study cohort. The median follow-up was 4.2 years. In multivariate analyses, both tumor-infiltrating lymphocytes and nodal status were independent prognostic factors for distant relapse-free survival and overall survival in patients with a pCR. Patients with positive nodal status had significantly worse distant relapse-free survival (adjusted hazard ratio [aHR], 2.38) and overall survival (aHR, 3.45) compared with those with negative nodal status. When evaluating tumor-infiltrating lymphocytes at a predefined cutoff of 30%, patients with higher tumor-infiltrating lymphocyte levels demonstrated better survival outcomes. Patients with tumor-infiltrating lymphocyte levels ≥ 30% had a 5-year distant relapse-free survival elapsed survival rate of 96.3% compared with 89.5% in patients with levels < 30% (aHR, 0.42). Similarly, in patients with higher tumor-infiltrating lymphocyte levels, 5-year overall survival was 98.1% compared with 91.5% in those with lower levels (aHR, 0.33). When combining tumor-infiltrating lymphocyte and nodal status information, patients with low tumor-infiltrating lymphocyte levels and positive nodal involvement had significantly worse 5-year distant relapse-free survival compared with all other subgroups (82.6% vs at least 94.7%; aHR, 3.17). This finding held for 5-year overall survival (84.3% vs at least 97%; aHR, 5.09). Sensitivity analyses confirmed the study findings for both distant relapse-free survival and overall survival. 'This is a simple, cost-effective, and universally applicable stratification tool that relies only on hematoxylin and eosin-stained slides and no proprietary technology, which can be implemented in treatment-tailoring trials,' Massa said. Massa noted that a prospective study to validate these findings is ongoing. Kevin Kalinsky, MD, with Winship Cancer Institute, Emory University, Atlanta, who served as study discussant, called the results 'intriguing' and 'hypothesis-generating.' Kalinsky said it will be important to validate whether low tumor-infiltrating lymphocytes are associated with worse outcomes regardless of pCR. And, if so, what is the role of antibody-drug conjugates with or without immunotherapy — a question that may be answered in the ongoing OptimICE-pCR trial, he added. Another question is whether patients with stage I TNBC and high tumor-infiltrating lymphocytes can opt out of systemic therapy, as is being explored in the OPTImaL and ETNA trials. Finally, Kalinsky said it will be worth exploring the use of tumor-infiltrating lymphocytes and other markers to tailor the selection of chemotherapy in TNBC, something the NeoTRACT trial is investigating.
