A prospective analysis of prognostic factors in the myelodysplastic syndromes.

In view of the uncertainty regarding the natural history and management of individuals with the myelodysplastic syndromes, a prospective study of 43 consecutive and previously untreated patients was undertaken in order to identify haematological features that could predict for poor prognosis. A significant correlation between percentage of blasts in the bone marrow, maturity index and the number of cell lineages involved was demonstrated with both the risk of leukaemic transformation and survival. It remains to be determined whether further accumulation of data will result in similar predictive values for karyotypic analysis, in vitro bone marrow culture and the species of plasminogen activator secreted by the cells. Since treatment ranges from red cell transfusion and administration of maturation-inducing agents to aggressive cytotoxic chemotherapy or bone marrow transplantation, the development of predictive models, based on relevant prognostic factors, remains the most rational basis for choices between these various options.