title: Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO study.
abstract: 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.
authors.affiliation: 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
authors.forename: Emilio Paolo
authors.initials: EP
authors.lastname: Alessandrino
authors.forename: Matteo Giovanni
authors.initials: MG
authors.lastname: Della Porta
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Luca
authors.initials: L
authors.lastname: Malcovati
authors.forename: Emanuele
authors.initials: E
authors.lastname: Angelucci
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Van Lint
authors.forename: Michele
authors.initials: M
authors.lastname: Falda
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.forename: Massimo
authors.initials: M
authors.lastname: Bernardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Guidi
authors.forename: Barbarella
authors.initials: B
authors.lastname: Lucarelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cerretti
authors.forename: Paola
authors.initials: P
authors.lastname: Marenco
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
authors.forename: Cristiana
authors.initials: C
authors.lastname: Pascutto
authors.forename: Rosi
authors.initials: R
authors.lastname: Oneto
authors.forename: Laura
authors.initials: L
authors.lastname: Pirolini
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
mesh_terms: 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
chemical_list: D005293:Ferritins