Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome.
PURPOSE: To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). PATIENTS AND METHODS: We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. RESULTS: Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 × 10(9)/L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high (≥ 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P < .001). Increasing score was predictive of increased relapse (P < .001) and treatment-related mortality (P < .001) in the HLA-matched set and relapse (P < .001) in the HLA-mismatched cohort. CONCLUSION: The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.
Shaffer, BC; Ahn, KW; Hu, Z-H; Nishihori, T; Malone, AK; Valcárcel, D; Grunwald, MR; Bacher, U; Hamilton, B; Kharfan-Dabaja, MA; Saad, A; Cutler, C; Warlick, E; Reshef, R; Wirk, BM; Sabloff, M; Fasan, O; Gerds, A; Marks, D; Olsson, R; Wood, WA; Costa, LJ; Miller, AM; Cortes, J; Daly, A; Kindwall-Keller, TL; Kamble, R; Rizzieri, DA; Cahn, J-Y; Gale, RP; William, B; Litzow, M; Wiernik, PH; Liesveld, J; Savani, BN; Vij, R; Ustun, C; Copelan, E; Popat, U; Kalaycio, M; Maziarz, R; Alyea, E; Sobecks, R; Pavletic, S; Tallman, M; Saber, W
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