title: Novel disease burden assessment predicts allogeneic transplantation outcomes in myelodysplastic syndrome.
abstract: Among patients with myelodysplastic syndrome (MDS) undergoing hematopoietic cell transplantation (HCT), the impact of residual pretransplant cytogenetically abnormal cells on outcomes remains uncertain. We analyzed HCT outcomes by time of transplant disease variables, including (1) blast percentage, (2) percentage of cytogenetically abnormal cells and (3) Revised International Prognostic Scoring System (R-IPSS) cytogenetic classification. We included 82 MDS patients (median age 51 years (range 18-71)) transplanted between 1995 and 2013 with abnormal diagnostic cytogenetics. Patients with higher percentages of cytogenetically abnormal cells experienced inferior 5-year survival (37-76% abnormal cells: relative risk (RR) 2.9; 95% confidence interval (CI) 1.2-7.2; P=0.02; and 77-100% abnormal cells: RR 5.6; 95% CI 1.9-19.6; P<0.01). Patients with >10% blasts also had inferior 5-year survival (RR 2.9; 95% CI 1.1-7.2; P=0.02) versus patients with ⩽2% blasts. Even among patients with ⩽2% blasts, patients with 77-100% cytogenetically abnormal cells had poor survival (RR 4.4; 95% CI 1.1-18.3; P=0.04). Increased non-relapse mortality (NRM) was observed with both increasing blast percentages (P<0.01) and cytogenetically abnormal cells at transplant (P=0.01) in multivariate analysis. We observed no impact of disease burden characteristics on relapse outcomes due to high 1-year NRM. In conclusion, both blast percentage and percentage of cytogenetically abnormal cells reflect MDS disease burden and predict post-HCT outcomes.
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Trottier
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Sachs
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: DeFor
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: L
authors.initials: L
authors.lastname: Shune
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Dolan
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: E D
authors.initials: ED
authors.lastname: Warlick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D017281:Cost of Illness; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy; D015996:Survival Rate