title: IPSS poor-risk karyotype as a predictor of outcome for patients with myelodysplastic syndrome following myeloablative stem cell transplantation.
abstract: The optimal therapy for myelodysplastic syndrome (MDS) is allogeneic bone marrow (BM) or blood (BSC) stem cell transplantation (SCT), although outcomes are limited by nonrelapse mortality (NRM) and relapse. A retrospective review was performed of 156 patients who underwent SCT (114 BM, 42 BSC) for MDS or secondary acute myelogenous leukemia (sAML) at our institution. Fifty-five patients remain in continuous complete remission: 35 BM recipients and 20 BSC recipients (median follow-up 139 and 89 months, respectively). Estimated 7-year event-free survival (EFS), NRM, and risk of relapse (ROR) are 33% (95% confidence intervals [CI] 25%-43%), 42% (CI 33%-51%), and 25% (CI 17%-33%) for the BM cohort and 45% (CI 32%-64%, P= .07), 32% (CI 18%-47%, P= .15), and 23% (CI 11%-37%, P= .79) for the BSC cohort. Multivariate analysis showed IPSS poor-risk cytogenetics (P< .001), time from diagnosis to SCT (P< .001), FAB subgroup (P= .001), recipients not in complete remission (CR1) at SCT (P= .005), and the development of acute graft-versus-host disease (aGVHD) (P= .04) were all predictive of an inferior EFS. The FAB subgroup (P= .002), poor-risk karyotype (P= .004), and non-CR1 status also correlated with ROR in multivariate analysis. EFS for poor-risk karyotype patients was superior after receiving BSC compared to BM (39% versus 6%, P< .001). SCT outcomes in MDS/sAML are strongly associated with the IPSS cytogenetic risk group, although the use of BSC in poor-risk karyotype patients may lead to a more favorable long-term EFS.
authors.affiliation: The Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver General Hospital, British Columbia Cancer Agency and the University of British Columbia, Vancouver, BC, Canada. tnevill@bccancer.bc.ca
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Nevill
authors.forename: John D
authors.initials: JD
authors.lastname: Shepherd
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Sutherland
authors.forename: Yasser R
authors.initials: YR
authors.lastname: Abou Mourad
authors.forename: Julye C
authors.initials: JC
authors.lastname: Lavoie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Nantel
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Toze
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hogge
authors.forename: Donna L
authors.initials: DL
authors.lastname: Forrest
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Song
authors.forename: Maryse M
authors.initials: MM
authors.lastname: Power
authors.forename: Janet Y
authors.initials: JY
authors.lastname: Nitta
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Dai
authors.forename: Clayton A
authors.initials: CA
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000401:mortality; D020732:Cytogenetic Analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D007621:Karyotyping; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000401:mortality* / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult