Brian C Shaffer1, Kwang Woo Ahn1, Zhen-Huan Hu1, Taiga Nishihori1, Adriana K Malone1, David Valcárcel1, Michael R Grunwald1, Ulrike Bacher1, Betty Hamilton1, Mohamed A Kharfan-Dabaja1, Ayman Saad1, Corey Cutler1, Erica Warlick1, Ran Reshef1, Baldeep Mona Wirk1, Mitchell Sabloff1, Omotayo Fasan1, Aaron Gerds1, David Marks1, Richard Olsson1, William Allen Wood1, Luciano J Costa1, Alan M Miller1, Jorge Cortes1, Andrew Daly1, Tamila L Kindwall-Keller1, Rammurti Kamble1, David A Rizzieri1, Jean-Yves Cahn1, Robert Peter Gale1, Basem William1, Mark Litzow1, Peter H Wiernik1, Jane Liesveld1, Bipin N Savani1, Ravi Vij1, Celalettin Ustun1, Edward Copelan1, Uday Popat1, Matt Kalaycio1, Richard Maziarz1, Edwin Alyea1, Ron Sobecks1, Steven Pavletic1, Martin Tallman1, Wael Saber1. 1. Brian C. Shaffer and Martin Tallman, Memorial Sloan Kettering Cancer Center; Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai; Ran Reshef, Columbia University Medical Center, New York; Mark Litzow, Mayo Clinic Rochester; Jane Liesveld, University of Rochester Medical Center, Rochester; Peter H. Wiernik, Our Lady of Mercy Medical Center, Bronx, NY; Kwang Woo Ahn, Zhen-Huan Hu, and Wael Saber, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Taiga Nishihori and Mohamed A. Kharfan-Dabaja, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; David Valcárcel, Hospital Vall d'Hebron, Barcelona, Spain; Michael R. Grunwald, Omotayo Fasan, and Edward Copelan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte; William Allen Wood, University of North Carolina at Chapel Hill, Chapel Hill; David A. Rizzieri, Duke University Medical Center, Durham, NC; Ulrike Bacher, University of Medicine Göttingen, Göttingen, Germany; Betty Hamilton and Aaron Gerds, Cleveland Clinic Taussig Cancer Institute; Matt Kalaycio and Ron Sobecks, Cleveland Clinic Foundation, Cleveland; Basem William, Ohio State University Medical Center, Columbus, OH; Ayman Saad and Luciano J. Costa, University of Alabama at Birmingham, Birmingham, AL; Corey Cutler and Edwin Alyea, Dana-Farber Cancer Institute, Boston, MA; Erica Warlick and Celalettin Ustun, University of Minnesota Medical Center, Minneapolis, MN; Baldeep Mona Wirk, Seattle Cancer Care Alliance, Seattle, WA; Mitchell Sabloff, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Andrew Daly, Tom Baker Cancer Center, Calgary, Alberta, Canada; David Marks, University Hospitals Bristol National Health Service Trust, Bristol; Robert Peter Gale, Imperial College London, London, United Kingdom; Richard Olsson, Karolinska Institutet, Stockholm, Sweden; Alan M. Miller, Baylor University Medical Center; Rammurti Kamble
Abstract
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.
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.
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