title: Prognostic pre-transplant factors in myelodysplastic syndromes primarily treated by high dose allogeneic hematopoietic stem cell transplantation: a retrospective study of the MDS subcommittee of the CMWP of the EBMT.
abstract: Many pre-transplant factors are known to influence the outcome of allogeneic stem cell transplantation (SCT) treatment in myelodysplastic syndromes (MDS). However, patient cohorts are often heterogeneous by disease stage and treatment modalities, which complicates interpretation of the results. This study aimed to obtain a homogeneous patient cohort by including only de novo MDS patients who received upfront allogeneic SCT after standard high dose myelo-ablative conditioning. The effect of pre-transplant factors such as age, disease stage, transfusions, iron parameters and comorbidity on overall survival (OS), non-relapse mortality (NRM), and relapse incidence (RI) was evaluated in 201 patients. In this cohort, characterized by low comorbidity and a short interval between diagnosis and transplantation, NRM was the most determinant factor for survival after SCT (47 % after 2-year follow-up). WHO classification and transfusion burden were the only modalities with a significant impact on overall survival after SCT. Estimated hazard ratios (HR) showed a strongly increased risk of death, NRM and RI, in patients with a high transfusion-burden (HR 1.99; P = 0.006, HR of 1.89; P = 0.03 and HR 2.67; P = 0.03). The HR's for ferritin level and comorbidity were not significantly increased.
authors.affiliation: VU University Medical Center, Amsterdam, The Netherlands. e.cremers@vumc.nl.|Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. e.cremers@vumc.nl.
authors.forename: E M P
authors.initials: EM
authors.lastname: Cremers
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Biezen
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L C
authors.initials: LC
authors.lastname: de Wreede
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Scholten
authors.affiliation: Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Vitek
authors.affiliation: University of Freiburg, Freiburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.affiliation: Universitatsklinikum Dresden, Dresden, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Platzbecker
authors.affiliation: University Hospital, Essen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Beelen
authors.affiliation: Deutsche Klinik fur Diagnostik and KMT, Wiesbaden, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schwerdtfeger
authors.affiliation: Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Volin
authors.affiliation: Evangelismos Hospital, Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Harhalakis
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Blijlevens
authors.affiliation: Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: University Hospital Eppendorf, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.affiliation: Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: de Witte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000401:mortality / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Allogeneic hematopoietic stem cell transplantation; Allogeneic stem cell transplantation; Comorbidity; Iron overload; Myelodysplastic syndromes; Prognosis; Red blood cell transfusion