title: Impact of the revised International Prognostic Scoring System, cytogenetics and monosomal karyotype on outcome after allogeneic stem cell transplantation for myelodysplastic syndromes and secondary acute myeloid leukemia evolving from myelodysplastic syndromes: a retrospective multicenter study of the European Society of Blood and Marrow Transplantation.
abstract: The aim of this study was to determine the impact of the revised 5-group International Prognostic Scoring System cytogenetic classification on outcome after allogeneic stem cell transplantation in patients with myelodysplastic syndromes or secondary acute myeloid leukemia who were reported to the European Society for Blood and Marrow Transplantation database. A total of 903 patients had sufficient cytogenetic information available at stem cell transplantation to be classified according to the 5-group classification. Poor and very poor risk according to this classification was an independent predictor of shorter relapse-free survival (hazard ratio 1.40 and 2.14), overall survival (hazard ratio 1.38 and 2.14), and significantly higher cumulative incidence of relapse (hazard ratio 1.64 and 2.76), compared to patients with very good, good or intermediate risk. When comparing the predictive performance of a series of Cox models both for relapse-free survival and for overall survival, a model with simplified 5-group cytogenetics (merging very good, good and intermediate cytogenetics) performed best. Furthermore, monosomal karyotype is an additional negative predictor for outcome within patients of the poor, but not the very poor risk group of the 5-group classification. The revised International Prognostic Scoring System cytogenetic classification allows patients with myelodysplastic syndromes to be separated into three groups with clearly different outcomes after stem cell transplantation. Poor and very poor risk cytogenetics were strong predictors of poor patient outcome. The new cytogenetic classification added value to prediction of patient outcome compared to prediction models using only traditional risk factors or the 3-group International Prognostic Scoring System cytogenetic classification.
authors.affiliation: Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany koenecke.christian@mh-hannover.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Koenecke
authors.affiliation: Institute of Cell and Molecular Pathology, Hannover Medical School, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Göhring
authors.affiliation: Department of Medical Statistics LUMC, Leiden, The Netherlands DKMS, German Bone Marrow Donor Center, Cologne, Germany.
authors.forename: Liesbeth C
authors.initials: LC
authors.lastname: de Wreede
authors.affiliation: Department of Medical Statistics LUMC, Leiden, The Netherlands.
authors.forename: Anja
authors.initials: A
authors.lastname: van Biezen
authors.affiliation: University of Cologne, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.affiliation: Helsinki University Central Hospital, Finland.
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.affiliation: University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.affiliation: University of Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Schaap
authors.affiliation: Hopital St. Louis, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: University Hospital, Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.affiliation: Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Cornelissen
authors.affiliation: University Hospital, Essen, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.affiliation: Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Heuser
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: de Witte
authors.affiliation: University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D020732:Cytogenetic Analysis; D005060:Europe; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D059785:Karyotype; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012107:Research Design; D012189:Retrospective Studies; D012306:Risk; D012955:Societies, Medical; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents