title: A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.
abstract: Bone marrow transplantation (BMT) can cure myelodysplastic syndrome (MDS), although transplantation carries significant risks of morbidity and mortality. Because the optimal timing of HLA-matched BMT for MDS is unknown, we constructed a Markov model to examine 3 transplantation strategies for newly diagnosed MDS: transplantation at diagnosis, transplantation at leukemic progression, and transplantation at an interval from diagnosis but prior to leukemic progression. Analyses using individual patient risk-assessment data from transplantation and nontransplantation registries were performed for all 4 International Prognostic Scoring System (IPSS) risk groups with adjustments for quality of life (QoL). For low and intermediate-1 IPSS groups, delayed transplantation maximized overall survival. Transplantation prior to leukemic transformation was associated with a greater number of life years than transplantation at the time of leukemic progression. In a cohort of patients under the age of 40 years, an even more marked survival advantage for delayed transplantation was noted. For intermediate-2 and high IPSS groups, transplantation at diagnosis maximized overall survival. No changes in the optimal transplantation strategies were noted when QoL adjustments were incorporated. For low- and intermediate-1-risk MDS, delayed BMT is associated with maximal life expectancy, whereas immediate transplantation for intermediate-2- and high-risk disease is associated with maximal life expectancy.
authors.affiliation: International Bone Marrow Transplant Registry, Medical College of Wisconsin, 8701 Watertown Plank Rd, PO Box 26509, Milwaukee, WI 53226, USA.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Peter
authors.initials: P
authors.lastname: Greenberg
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Claudio
authors.initials: C
authors.lastname: Anasetti
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Milone
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Schultz
authors.forename: Michael E
authors.initials: ME
authors.lastname: Trigg
authors.forename: Armand
authors.initials: A
authors.lastname: Keating
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome