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Allografting

Allogeneic hematopoietic cell transplantation for myelodysplastic syndrome: prognostic significance of pre-transplant IPSS score and comorbidity

Bone Marrow Transplantation volume 45, pages 450–457 (2010)Cite this article

Abstract

We analyzed the clinical significance of pre-transplant International Prognostic Scoring System (IPSS) score and comorbidity in 68 patients who underwent allogeneic hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS) (n=48) or acute myeloid leukemia evolved from MDS (n=20) between December 1995 and January 2008 in a single institute. During a median follow-up period of 41.0 months (range, 3.2–132.0 months), 27 patients died, and 7 relapsed. The 5-year probabilities of overall survival (OS) and event-free survival (EFS) were 60.0 and 57.4%, respectively, and the 5-year cumulative incidences of non-relapse mortality (CINRM) and relapse were 32.7 and 9.9%, respectively. OS, EFS, and CINRM were significantly different according to pre-transplant IPSS score and presence of pre-transplant comorbidity, which were independent risk factors along with Karnofsky performance score in multivariate analyses. In conclusion, pre-transplant IPSS score and comorbidity may stratify the risk of post transplant outcomes in MDS.

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References

  1. Nimer SD . Myelodysplastic syndromes. Blood 2008; 111: 4841–4851.

    Article  CAS  PubMed  Google Scholar 

  2. Anderson JE . Bone marrow transplantation for myelodysplasia. Blood Rev 2000; 14: 63–77.

    Article  CAS  PubMed  Google Scholar 

  3. Deeg HJ . Optimization of transplant regimens for patients with myelodysplastic syndrome (MDS). Hematology Am Soc Hematol Educ Program 2005, 167–173.

    Article  Google Scholar 

  4. Ingram W, Lim ZY, Mufti GJ . Allogeneic transplantation for myelodysplastic syndrome (MDS). Blood Rev 2007; 21: 61–71.

    Article  PubMed  Google Scholar 

  5. Runde V, de Witte T, Arnold R, Gratwohl A, Hermans J, van Biezen A et al. Bone marrow transplantation from HLA-identical siblings as first-line treatment in patients with myelodysplastic syndromes: early transplantation is associated with improved outcome. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1998; 21: 255–261.

    Article  CAS  PubMed  Google Scholar 

  6. Sierra J, Perez WS, Rozman C, Carreras E, Klein JP, Rizzo JD et al. Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia. Blood 2002; 100: 1997–2004.

    CAS  PubMed  Google Scholar 

  7. Arnold R, de Witte T, van Biezen A, Hermans J, Jacobsen N, Runde V et al. Unrelated bone marrow transplantation in patients with myelodysplastic syndromes and secondary acute myeloid leukemia: an EBMT survey. European Blood and Marrow Transplantation Group. Bone Marrow Transplant 1998; 21: 1213–1216.

    Article  CAS  PubMed  Google Scholar 

  8. Castro-Malaspina H, Harris RE, Gajewski J, Ramsay N, Collins R, Dharan B et al. Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood 2002; 99: 1943–1951.

    Article  CAS  PubMed  Google Scholar 

  9. Deeg HJ, Storer B, Slattery JT, Anasetti C, Doney KC, Hansen JA et al. Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome. Blood 2002; 100: 1201–1207.

    Article  CAS  PubMed  Google Scholar 

  10. Ooi J . The efficacy of unrelated cord blood transplantation for adult myelodysplastic syndrome. Leuk Lymphoma 2006; 47: 599–602.

    Article  PubMed  Google Scholar 

  11. de Witte T, Pikkemaat F, Hermans J, van Biezen A, Mackinnan S, Cornelissen J et al. Genotypically nonidentical related donors for transplantation of patients with myelodysplastic syndromes: comparison with unrelated donor transplantation and autologous stem cell transplantation. Leukemia 2001; 15: 1878–1884.

    Article  CAS  PubMed  Google Scholar 

  12. Anderson JE, Appelbaum FR, Schoch G, Gooley T, Anasetti C, Bensinger WI et al. Allogeneic marrow transplantation for refractory anemia: a comparison of two preparative regimens and analysis of prognostic factors. Blood 1996; 87: 51–58.

    CAS  PubMed  Google Scholar 

  13. Appelbaum FR, Barrall J, Storb R, Fisher LD, Schoch G, Ramberg RE et al. Bone marrow transplantation for patients with myelodysplasia. Pretreatment variables and outcome. Ann Intern Med 1990; 112: 590–597.

    Article  CAS  PubMed  Google Scholar 

  14. de Witte T, Hermans J, van Biezen A, Vernant J, Kolb H, Zwaan F et al. Prognostic variables in bone marrow transplantation for secondary leukaemia and myelodysplastic syndromes: a survey of the working party on leukaemia. Bone Marrow Transplant 1991; 7: 40.

    PubMed  Google Scholar 

  15. Nevill TJ, Fung HC, Shepherd JD, Horsman DE, Nantel SH, Klingemann HG et al. Cytogenetic abnormalities in primary myelodysplastic syndrome are highly predictive of outcome after allogeneic bone marrow transplantation. Blood 1998; 92: 1910–1917.

    CAS  PubMed  Google Scholar 

  16. Sutton L, Chastang C, Ribaud P, Jouet JP, Kuentz M, Attal M et al. Factors influencing outcome in de novo myelodysplastic syndromes treated by allogeneic bone marrow transplantation: a long-term study of 71 patients Societe Francaise de Greffe de Moelle. Blood 1996; 88: 358–365.

    CAS  PubMed  Google Scholar 

  17. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–2088.

    CAS  PubMed  Google Scholar 

  18. Lee JH, Shin YR, Lee JS, Kim WK, Chi HS, Park CJ et al. Application of different prognostic scoring systems and comparison of the FAB and WHO classifications in Korean patients with myelodysplastic syndrome. Leukemia 2003; 17: 305–313.

    Article  PubMed  Google Scholar 

  19. Malcovati L, Germing U, Kuendgen A, Della Porta MG, Pascutto C, Invernizzi R et al. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol 2007; 25: 3503–3510.

    Article  PubMed  Google Scholar 

  20. Appelbaum FR, Anderson J . Allogeneic bone marrow transplantation for myelodysplastic syndrome: outcomes analysis according to IPSS score. Leukemia 1998; 12: S25–S29.

    Article  PubMed  Google Scholar 

  21. Rubio S, Martins C, Lacerda JF, Carmo JA, Lourenco F, Lacerda JM . Allogeneic stem cell transplantation in patients with myelodysplastic syndrome: outcome analysis according to the International Prognostic Scoring System. Acta Med Port 2006; 19: 343–347.

    CAS  PubMed  Google Scholar 

  22. Sorror ML, Giralt S, Sandmaier BM, De Lima M, Shahjahan M, Maloney DG et al. Hematopoietic cell transplantation specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 2007; 110: 4606–4613.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sorror ML, Maris MB, Storer B, Sandmaier BM, Diaconescu R, Flowers C et al. Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplantation comorbidities. Blood 2004; 104: 961–968.

    Article  CAS  PubMed  Google Scholar 

  25. Sorror ML, Sandmaier BM, Storer BE, Maris MB, Baron F, Maloney DG et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 2007; 25: 4246–4254.

    Article  PubMed  Google Scholar 

  26. Sorror ML, Storer BE, Sandmaier BM, Maloney DG, Chauncey TR, Langston A et al. Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 2008; 112: 1992–2001.

    Article  PubMed  Google Scholar 

  27. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  28. Tutschka PJ, Beschorner WE, Hess AD, Santos GW . Cyclosporin-A to prevent graft-versus-host disease: a pilot study in 22 patients receiving allogeneic marrow transplants. Blood 1983; 61: 318–325.

    CAS  PubMed  Google Scholar 

  29. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  30. Przepiorka D, Anderlini P, Saliba R, Cleary K, Mehra R, Khouri I et al. Chronic graft-versus-host disease after allogeneic blood stem cell transplantation. Blood 2001; 98: 1695–1700.

    Article  CAS  PubMed  Google Scholar 

  31. Cox DR . Regression models and life tables. J R Stat Soc B 1972; 34: 187–202.

    Google Scholar 

  32. Seal HL . Studies in the history of probability and statistics: XXXV multiple decrements or competing risks. Biometrika 1977; 64: 429–439.

    Google Scholar 

  33. Gray RJ . A class of K-sample tests for comparing the cumulative incidence of a completing risk. Ann Stat 1988; 16: 1141–1154.

    Article  Google Scholar 

  34. Barrett AJ, Savani BN . Allogeneic stem cell transplantation for myelodysplastic syndrome. Semin Hematol 2008; 45: 49–59.

    Article  CAS  PubMed  Google Scholar 

  35. Marcondes M, Deeg HJ . Hematopoietic cell transplantation for patients with myelodysplastic syndromes (MDS): when, how and for whom? Best Pract Res Clin Haematol 2008; 21: 67–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 1982; 51: 189–199.

    Article  CAS  PubMed  Google Scholar 

  37. Bennett JM . World Health Organization classification of the acute leukemias and myelodysplastic syndrome. Int J Hematol 2000; 72: 131–133.

    CAS  PubMed  Google Scholar 

  38. Farina L, Bruno B, Patriarca F et al. The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation. Leukemia 2009; 23: 1131–1138.

    Article  CAS  PubMed  Google Scholar 

  39. Alyea EP, Kim HT, Ho V, Cutler C, DeAngelo DJ, Stone R et al. Impact of conditioning regimen intensity on outcome of allogeneic hematopoietic cell transplantation for advanced acute myelogenous leukemia and myelodysplastic syndrome. Biol Blood Marrow Transplant 2006; 12: 1047–1055.

    Article  PubMed  Google Scholar 

  40. de Lima M, Anagnostopoulos A, Munsell M, Shahjahan M, Ueno N, Ippoliti C et al. Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation. Blood 2004; 104: 865–872.

    Article  CAS  PubMed  Google Scholar 

  41. Martino R, Iacobelli S, Brand R, Jansen T, van Biezen A, Finke J et al. Retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic hematopoietic stem cell transplantation using HLA-identical sibling donors in myelodysplastic syndromes. Blood 2006; 108: 836–846.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (A062254).

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Authors and Affiliations

  1. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    J-H Lee, J-H Lee, S-N Lim, D-Y Kim, S H Kim, Y-S Lee, Y-A Kang, S-I Kang, M J Jeon, M Seol & K-H Lee

  2. Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    E-J Seo, H S Chi, C J Park & S Jang

  3. Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    S-C Yun

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Lee, JH., Lee, JH., Lim, SN. et al. Allogeneic hematopoietic cell transplantation for myelodysplastic syndrome: prognostic significance of pre-transplant IPSS score and comorbidity. Bone Marrow Transplant 45, 450–457 (2010). https://doi.org/10.1038/bmt.2009.190

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