Outcome following haematopoietic cell transplantation in patients with myelodysplasia and del (5q) karyotypes.
The deletion (5q) karyotype [del (5q)] in patients with myelodysplastic syndrome (MDS) is considered a good risk feature, while the impact of del (5q) combined with other karyotypic abnormalities [del (5q)+] is less well defined. We analysed the outcome of haematopoietic cell transplants (HCT) in patients with MDS with del (5q) or del (5q)+. Fifty-seven patients, aged 6-72 years, with MDS and del (5q) abnormalities received HCT from related (n = 32) or unrelated (n = 25) donors. By French-American-British (FAB) criteria, 27 patients had refractory anaemia (RA), 10 RA with excess blasts (RAEB), eight RAEB in transformation (RAEB-T) and 12 acute myeloid leukaemia evolving from MDS (tAML). Non-relapse mortality at 1-year post-transplantation was 30% for del (5q) and 38% for del (5q)+ patients. Relapse occurred in one of 20 del (5q) patients and 15 of 37 del (5q)+ patients (P = 0.001). After adjusting for del (5q) status, blast count (<5%) was the only factor significantly associated with relapse-free survival. Patients with del (5q), either as a '5q- syndrome' or with MDS in general, had better outcomes than did patients with del (5q)+. The indication for transplantation in patients with del (5q) was generally severe cytopenias, compared with disease progression to a more advanced FAB stage in patients with del (5q)+. Conceivably, outcome for patients with del (5q)+ would be improved with transplantation earlier in the disease course.
Stewart
B
B
Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Verdugo
M
M
Guthrie
K A
KA
Appelbaum
F
F
Deeg
H J
HJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000753:Anemia, Refractory / Q000235:genetics / Q000401:mortality / Q000601:surgery; D000754:Anemia, Refractory, with Excess of Blasts / Q000235:genetics / Q000401:mortality / Q000601:surgery; D002423:Cause of Death; D002648:Child; D002869:Chromosome Aberrations; D002872:Chromosome Deletion; D002895:Chromosomes, Human, Pair 5; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007951:Leukemia, Myeloid / Q000235:genetics / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000235:genetics* / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D019172:Transplantation Conditioning; D016896:Treatment Outcome