Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO study.
BACKGROUND
Transfusion-dependency affects the natural history of myelodysplastic syndromes. Secondary iron overload may concur to this effect. The relative impact of these factors on the outcome of patients with myelodysplastic syndrome receiving allogeneic stem-cell transplantation remains to be clarified.


METHODS
We retrospectively evaluated the prognostic effect of transfusion history and iron overload on the post-transplantation outcome of 357 patients with myelodysplastic syndrome reported to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) registry between 1997 and 2007.


RESULTS
Transfusion-dependency was independently associated with reduced overall survival (hazard ratio=1.48, P=0.017) and increased non-relapse mortality (hazard ratio=1.68, P=0.024). The impact of transfusion-dependency was noted only in patients receiving myeloablative conditioning (overall survival: hazard ratio=1.76, P=0.003; non-relapse mortality: hazard ratio=1.70, P=0.02). There was an inverse relationship between transfusion burden and overall survival after transplantation (P=0.022); the outcome was significantly worse in subjects receiving more than 20 red cell units. In multivariate analysis, transfusion-dependency was found to be a risk factor for acute graft-versus-host disease (P=0.04). Among transfusion-dependent patients undergoing myeloablative allogeneic stem cell transplantation, pre-transplantation serum ferritin level had a significant effect on overall survival (P=0.01) and non-relapse mortality (P=0.03). This effect was maintained after adjusting for transfusion burden and duration, suggesting that the negative effect of transfusion history on outcome might be determined at least in part by iron overload.


CONCLUSIONS
Pre-transplantation transfusion history and serum ferritin have significant prognostic value in patients with myelodysplastic syndrome undergoing myeloablative allogeneic stem cell transplantation, inducing a significant increase of non-relapse mortality. These results indicate that transfusion history should be considered in transplantation decision-making in patients with myelodysplastic syndrome.
Alessandrino
Emilio Paolo
EP
Department of Hematology Oncology, University of Pavia, Fondazione Policlinico San Matteo, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy. alessandrino@smatteo.pv.it
Della Porta
Matteo Giovanni
MG
Bacigalupo
Andrea
A
Malcovati
Luca
L
Angelucci
Emanuele
E
Van Lint
Maria Teresa
MT
Falda
Michele
M
Onida
Francesco
F
Bernardi
Massimo
M
Guidi
Stefano
S
Lucarelli
Barbarella
B
Rambaldi
Alessandro
A
Cerretti
Raffaella
R
Marenco
Paola
P
Pioltelli
Pietro
P
Pascutto
Cristiana
C
Oneto
Rosi
R
Pirolini
Laura
L
Fanin
Renato
R
Bosi
Alberto
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D019190:Iron Overload / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D005293:Ferritins