title: Five-group cytogenetic risk classification, monosomal karyotype, and outcome after hematopoietic cell transplantation for MDS or acute leukemia evolving from MDS.
abstract: Clonal cytogenetic abnormalities are a major risk factor for relapse after hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS). We determined the impact of the recently established 5-group cytogenetic classification of MDS on outcome after HCT. Results were compared with the impact of the International Prognostic Scoring System (IPSS) 3 cytogenetic risk groups, and the additional effect of a monosomal karyotype was assessed. The study included data on 1007 patients, 1-75 years old (median 45 years), transplanted from related (n = 547) or unrelated (n = 460) donors. Various conditioning regimens were used, and marrow, peripheral blood, or cord blood served as stem cell source. Both IPSS and 5-group cytogenetic risk classifications were significantly associated with post-HCT relapse and mortality, but the 5-group classification discriminated more clearly among the lowest- and highest-risk patients. A monosomal karyotype tended to further increase the rates of relapse and mortality, even after considering the IPSS or 5-group classifications. In addition, the pathologic disease category correlated with both relapse and mortality. Mortality was also impacted by patient age, donor type, conditioning regimen, platelet count, and etiology of MDS. Although mortality declined significantly in recent years, novel strategies are needed to overcome the barrier of high-risk cytogenetics.
authors: Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, WA 98109-1024, USA. jdeeg@fhcrc.org
authors: H Joachim
authors: HJ
authors: Deeg
authors: Bart L
authors: BL
authors: Scott
authors: Min
authors: M
authors: Fang
authors: Howard M
authors: HM
authors: Shulman
authors: Boglarka
authors: B
authors: Gyurkocza
authors: David
authors: D
authors: Myerson
authors: John M
authors: JM
authors: Pagel
authors: Uwe
authors: U
authors: Platzbecker
authors: Aravind
authors: A
authors: Ramakrishnan
authors: Jerald P
authors: JP
authors: Radich
authors: Brenda M
authors: BM
authors: Sandmaier
authors: Mohamed
authors: M
authors: Sorror
authors: Derek L
authors: DL
authors: Stirewalt
authors: Wendy A
authors: WA
authors: Wilson
authors: Rainer
authors: R
authors: Storb
authors: Frederick R
authors: FR
authors: Appelbaum
authors: Ted
authors: T
authors: Gooley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020732:Cytogenetic Analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D059785:Karyotype; D015470:Leukemia, Myeloid, Acute / Q000145:classification* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000145:classification* / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult