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need for transfusion (P <0.001). Secondary iron overload affected the survival of transfusion-dependent patients (P 0.02). The WHO classification was able to stratify survival of patients with low (P 0.01) and intermediate-1 IPSS (P 0.005). In summary, these data show that the WHO classification further improves the prognostic value of the IPSS in the low and intermediate-1 groups. MDS patients with pure erythroid dysplasia represent a subset of individuals with favorable outcome in which a conservative approach is advisable.

I P ~ CHRONIC MYELOMONOCYTIC LEUKEMIA: IPSS BEST DISCRIMINATES PATIENTS WITH WORSE PROGNOSIS, IN BOTH THE DYSPLASTIC AND THE PROLIFERATIVE SUBTYPE

A.S. Symeonidis*, V. Lambropoulou, E. Michalis, A. Chatzivassilis, A. Kouraklis, A. Galanopoulos, R Matsouka, N. Anagnostopoulos, R Iliakis, N. Zoumbos. University of Patras Medical School, Greece *E-maih argisym@hotmail.com

In an effort to recognize the better fitted prognostic model for patients with chronic myelomonocytic leukemia, we retrospectively analyzed the clinical data of 143 patients. According to WHO classification 57 patients belonged to the dysplastic, and the remaining 86 to the proliferative subtype. Twenty-three patients (40.3%) of the dysplastic subtype evolved to the proliferative one, and totally, 47 patients (32.9%), 10/57 of the dysplastic (17.5%) and 37/86 of the proliferative subtype (43%) transformed to AML, after a median of 25 months from diagnosis. The median overall survival was 28 months, and it was 41 months for the dysplastic and 19 months for the proliferative subtype. Patients' data at presentation were analyzed according to five prognostic systems proposed for patients with MDS, namely, IPSS, Bournemouth, Dusseldorf, Lille and Spanish (Sanz) score. Patients of the proliferative subtype were also analyzed according to Hasford's and Sokal's score, proposed for patients with chronic myelogenous leukemia. For the whole group of patients, as well as for each of the two subtypes separately, IPS S could better describe the aggressiveness of the disease (median survival in months: Low: 47, Intermediate-l: 29.5, Intermediate-2: 19, High: 13). Bournemouth and Spanish score could successfully stratify the dysplastic subtype, while Dusseldorf score was somewhat useful for the proliferative subtype. Lille, Hasford's and Sokal's scores had no predictive significance.

[ P ~ DETERMINATION OF THE RESPONSE TO ANEMIA INDEX (RAI) IN PATIENTS WITH MDS. RECOGNITION OF THIS PARAMETER AS A MAJOR PREDICTOR OF IN VIVO RESPONSE TO TREATMENT WITH rh-EPO

A.S. Symeonidis*, M. Leotsinidis, A. Kouraklis, N. Zoumbos. University of Patras Medical School, Greece *E-maih argisym@hotmail.com

We measured serum EPO in 211 patients with MDS, 156 of whom (74%) were later treated with rh-EPO. Sixty patients (38.5%) showed a favorable response, 38 a major (24.4%), and 22 a minor one (14.1%). The proposed threshold of 200 IU/1 could not safely predict the response, since 34 patients (21.8%) with serum EPO <200IU/1, did not respond to treatment, and 10 patients (6.4%) with EPO >200 IU/1 did respond. We have tested the Hb x log- EPO component as a reliable "Response to Anemia Index" (RAI) over 1200 anemic patients of various etiologies. This index is not influenced by the severity of anemia, averages 16.2±3.7 and ranges 8~5 , in >98.5% of the tested population. A blunted response can be arbitrarily determined as a RAI <2 SD, and an over-response as a value >2 SD of the mean. Responded patients had significantly lower RAI, compared to non responders (15.3±2.9 vs. 19.1±2.7, p 3.2x10 12). Only two patients (1.3%) with a RAI>20 and 12 patients (7.7%) with a RAI > 17 showed a favorable response. Conversely, 14 patients (8.9%, 8 of them with RAEB) with a RAI< 17 did not respond to treatment, and transformed rapidly to AML. It is concluded that RAI can reliably predict in vivo response to treatment with rh-EPO in patients with MDS.

[ P ~ PREVALENCE OF HTLV-I CARRIERS AMONG PATIENTS WITH MDS RAEB AND AML

K. Matsushita 1 *, H. Inoue 1 , A. Ozaki 1 , H. Fujiwara 1 , H. Kawada 1 , M. Yoshimitsu 1 , K. Arimura 1 , T. Kukita 2, T. Matsumoto 2, N. Arima 1 , C. Tei 3. 1Department of Hematology arid Immunology, Kagoshima University, 2Department of Hematology, Imamura Hospital, 3Department of Cardiovasczdar Medicine, Kagoshima University, Japan *E-maih kaku@m2 .ku fm.kagoshima-u.ac.j p

Background: Human T-lymphotropic virus type I (HTLV-I) is a causative agent of adult T-cell leukemia. We already reported high prevalence of HTLV-I carriers among MDS patients. In the present study, we examined the prevalence of HTLV-I carrier among patients with MDS refractory anemia with excess of blast (RAEB) and AML.

Method: Eighty-one patients with 30 MDS RAEB and 51 AML (6 M1, 16 iV12, 11 M3, 11 M4, 4 M5, 1 M6, and 2 M7

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patients) were examined for HTLV-I infection. The AML patients who had a history of MDS were excluded from AML patients. The ratio of gender and clinical type, age, the prevalence of chromosomal abnormalities of bone marrow cells were compared between the patients with HTLV-I infection and patients without infection.

Results: Ten patients with MDS RAEB (33%) and 7 patients with AML (14%) were positive for HTLV-I. Four of 7 AML patients were acute promyelocytic leukemia (APL). Clinical parameters were not significantly different. In the chromosomal analysis, del(20q) were seen in 3 MDS patients with infection. The complex abnormality, defined as more than 4 abnormalities, was seen in one patient with HTLV-I and in 6 without infection.

Conclusion: The prevalence of HTLV-I carriers was high in the patients with MDS RAEB and APL.

groups were distinguished with a 5-year survival rate of 69%, 37% and 5%. In 43% of patients survival was ~<20%.

In conclusion: this prognostic score is a valuable alternative for the IPSS in patients receiving intensive treatment including SCT.

• FRENCH REGISTRY OF GFM GROUP

F. Dreyfus 1 *, J. Feulllard 1 , M.J. Grange 1 , N. Casadevall 1 , M. Tulliez 1 , M. Imbert 1 , L. Roy 1 , E Isnard 1 , O. Beyne- Rauzy 1 , E. Duchayne 1 , B. Slama 1 , S. Cheze 1 , H. Dombret 1 , C. Hababou 2, S. Vaultier 1 , M. Guesnu 1 , E Picard 1 , R Fenaux 1 . 1Groupe Franfais des Myelodysplasies and : Ortho-Biotech, Die Janssen-Cilag, France *E-mail: sandrine.vaultier@cch.ap-hop-paris, fr

~ A NEW PROGNOSTIC SCORE FOR OUTCOME OF PATIENTS WITH HIGH-RISK MYELODYSPLASTIC SYNDROME (MDS) OR SECONDARY ACUTE MYELOID LEUKEMIA (SAML) AFTER INTENSIVE ANTILEUKEMIC TREATMENT

M. Oosterveld*, S. Suciu, LR Marie, A. Ferrant, R Muus, M. Delforge, E. Hellstrom-Lindberg, S. Amadori, E Beeldens, R. Willemze, T.M. De Witte. Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. On behalf of the EORTC, EBMZ SAKK, HOVON and Scandinavian Leukemia Groups, Netherlands *E-mail: M.Oost erveld@hemat.umcn.nl

High-risk MDS patients have a less favourable outcome after intensive antileukemic treatment compared with de novo AML patients. This may reflect both disease-related and patient-related factors.

The purpose of this analysis was to identify prognostic factors for outcome and to develop a prognostic score in 289 patients with high-risk MDS or sAML treated in the CRIANT study (EORTC 06961). Patients received remission-induction (ICE) and consolidation chemotherapy (IDIA). Post-consolidation treatment in patients with a donor consisted of allogeneic stem cell transplantation (SCT), patients lacking a donor were randomized between autologous SCT and a 2nd consolidation course. Median age was 52 years. CR rate was 59%. The 5-year overall survival (OS), disease-free survival and relapse rates were 27%, 28% and 62%, respectively. In multivariate analysis the following variables appeared independently prognostic for OS: IPSS cytogenetic risk group, age, number of cytopenias, white blood count and duration of AHD (antecedent hematologic disorder) >6 months. The percentage of bone marrow blasts appeared not prognostic for outcome. Based upon these results a prognostic score was designed. Three

Since November 2002 the GFM group created a prospective registry of myelodysplastic patients. 18 French centers participated in this registry. At this time 268 patients were included. There are 65% male and 25% female, median age 72 years (range 31 98); 89% are primitive and 11% secondary to chemotherapy, radiotherapy, hobby or professional exposition. The mean delay between the end of the treatment and the MDS is 69± months.

Anemia is present in 90% of cases at diagnosis, neutrope- nia in 35% and thrombopenia in 50%. Ferritin level 684mg (24 2750) and Epo level 105u (12 1360). WHO RA: 8%; RARS: 22%; RA-MD: 20%; RAEB-1 : 25%; RAEB-2:11%; 5 ~ : 11%; IPSS Low: 32%, Int-l: 133%, Int-2: 25%, High: 7%. Treatments included transfusions, erythropoietin, thalidomide, arsenic, tipifarnid and chemotherapy. The follow up of registry is carried out every 6 months. For all patients 50 pictures of the bone marrow are available for the gradation of dysplasia and exchangeable between all the centers of GFM group.

Diagnosis, Classification

P-20 APPLICATION OF WHO CLASSIFICATION IN CHINESE PATIENTS WITH PRIMARY MYELODYSPLASTIC SYNDROMES

Z. Xiao*, M. Yu, S. Liu, Y. Shao, Y. Hao. Institute of Hematology, CAMS & PUMC, China *E-mail: zjxiao@hotmail.com

In this study we provide a comparison of the FAB and WHO classifications by evaluating data from 237 well-documented patients with primary MDS (excluding CMML) whose disease was diagnosed at our institution and karyotypes were available between 1988 and 2003. 235 patients could be reclassified with WHO classification. The distribution of the patients according to the WHO