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Predictive factors for the outcome of allogeneic transplantation in patients with MDS stratified according to the revised IPSS-R.

Authors
  • Della Porta, Matteo G1
  • Alessandrino, Emilio Paolo
  • Bacigalupo, Andrea
  • van Lint, Maria Teresa
  • Malcovati, Luca
  • Pascutto, Cristiana
  • Falda, Michele
  • Bernardi, Massimo
  • Onida, Francesco
  • Guidi, Stefano
  • Iori, Anna Paola
  • Cerretti, Raffaella
  • Marenco, Paola
  • Pioltelli, Pietro
  • Angelucci, Emanuele
  • Oneto, Rosi
  • Ripamonti, Francesco
  • Bernasconi, Paolo
  • Bosi, Alberto
  • Cazzola, Mario
  • And 1 more
  • 1 Department of Hematology Oncology, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy; , (Italy)
Type
Published Article
Journal
Blood
Publisher
American Society of Hematology
Publication Date
Apr 10, 2014
Volume
123
Issue
15
Pages
2333–2342
Identifiers
DOI: 10.1182/blood-2013-12-542720
PMID: 24558201
Source
Medline
License
Unknown

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.

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