A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.
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.
Cutler
Corey S
CS
International Bone Marrow Transplant Registry, Medical College of Wisconsin, 8701 Watertown Plank Rd, PO Box 26509, Milwaukee, WI 53226, USA.
Lee
Stephanie J
SJ
Greenberg
Peter
P
Deeg
H Joachim
HJ
Pérez
Waleska S
WS
Anasetti
Claudio
C
Bolwell
Brian J
BJ
Cairo
Mitchell S
MS
Gale
Robert Peter
RP
Klein
John P
JP
Lazarus
Hillard M
HM
Liesveld
Jane L
JL
McCarthy
Philip L
PL
Milone
Gustavo A
GA
Rizzo
J Douglas
JD
Schultz
Kirk R
KR
Trigg
Michael E
ME
Keating
Armand
A
Weisdorf
Daniel J
DJ
Antin
Joseph H
JH
Horowitz
Mary M
MM
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