title: Predictive factors for the outcome of allogeneic transplantation in patients with MDS stratified according to the revised IPSS-R.
abstract: Approximately one-third of patients with myelodysplastic syndrome (MDS) receiving allogeneic hematopoietic stem cell transplantation (HSCT) are cured by this treatment. Treatment failure may be due to transplant complications or relapse. To identify predictive factors for transplantation outcome, we studied 519 patients with MDS or oligoblastic acute myeloid leukemia (AML, <30% marrow blasts) who received an allogeneic HSCT and were reported to the Gruppo Italiano Trapianto di Midollo Osseo registry between 2000 and 2011. Univariate and multivariate survival analyses were performed using Cox proportional hazards regression. High-risk category, as defined by the revised International Prognostic Scoring System (IPSS-R), and monosomal karyotype were independently associated with relapse and lower overall survival after transplantation. On the other hand, older recipient age and high hematopoietic cell transplantation-comorbidity index (HCT-CI) were independent predictors of nonrelapse mortality. Accounting for various combinations of patient's age, IPSS-R category, monosomal karyotype, and HCT-CI, the 5-year probability of survival after allogeneic HSCT ranged from 0% to 94%. This study indicates that IPSS-R risk category and monosomal karyotype are important factors predicting transplantation failure both in MDS and oligoblastic AML. In addition, it reinforces the concept that allogeneic HSCT offers optimal eradication of myelodysplastic hematopoiesis when the procedure is performed before MDS patients progress to advanced disease stages.
authors.affiliation: Department of Hematology Oncology, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy;
authors.forename: Matteo G
authors.initials: MG
authors.lastname: Della Porta
authors.forename: Emilio Paolo
authors.initials: EP
authors.lastname: Alessandrino
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: van Lint
authors.forename: Luca
authors.initials: L
authors.lastname: Malcovati
authors.forename: Cristiana
authors.initials: C
authors.lastname: Pascutto
authors.forename: Michele
authors.initials: M
authors.lastname: Falda
authors.forename: Massimo
authors.initials: M
authors.lastname: Bernardi
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.forename: Stefano
authors.initials: S
authors.lastname: Guidi
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Iori
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: Emanuele
authors.initials: E
authors.lastname: Angelucci
authors.forename: Rosi
authors.initials: R
authors.lastname: Oneto
authors.forename: Francesco
authors.initials: F
authors.lastname: Ripamonti
authors.forename: Paolo
authors.initials: P
authors.lastname: Bernasconi
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Mario
authors.initials: M
authors.lastname: Cazzola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult