Overview of myelodysplastic syndrome in Baghdad, Iraq- clinical picture and outcome

Background: Myelodysplastic syndromes (MDS) can represent a challenge in diagnosis and treatment because of heterogeneous presentation, unpredictable response to variable measures with propensity for leukemic transformation. Aim of study: To review MDS Iraqi patients in term of presentation, risk stratification and treatment options and to assess outcome of different treatment options in term of response criteria, quality of life and progression. Patients and method: a hospital based study conducted over a period of 21 months from January 2018 till October 2019 in different hematology centers in Baghdad. Any patient with primary or therapy related MDS diagnosed were enrolled in this study. Each patient stratified into different risk groups when applying cytogenetic versus non cytogenetic scoring systems, the therapeutic options for every patient. They observed for their response to different therapeutic modalities and any evidence of progression. Results: Mean age at diagnosis for MDS was 58.7± Anemia was the most common presenting symptom representing 68.4% of patients. MDS with excess blasts-II is forming 28.8%. Majority of patients categorized as intermediate risk group. Hypomethylating agents used for 50% of MDS patients while 32.1% received best available therapy. Those on HMA achieve partial remission in 7.1%, 25.2% reached to stable disease, hematological improvement in 25.2%. Death outcome in 21.6 with a mean survival is 7.7 months. Disease progression in 10.8%, 7.2% showed leukemic transformation. Conclusion: Iraqi MDS patients present at younger age with advanced manifestation that needs standard risk stratification. The non-cytogenetic score systems can't be of equivalent application even low resources circumstances.