Faculty Collaboration Database

Scoring System Prognostic of Outcome in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome. J Clin Oncol 2016 Jun 01;34(16):1864-71

Date

04/06/2016

Pubmed ID

27044940

Pubmed Central ID

PMC4966345

DOI

10.1200/JCO.2015.65.0515

Scopus ID

2-s2.0-84974539642 (requires institutional sign-in at Scopus site)   63 Citations

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.

Author List

Shaffer BC, Ahn KW, Hu ZH, 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 JY, 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

Authors

Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Female
Hematopoietic Stem Cell Transplantation
Histocompatibility Testing
Humans
Male
Middle Aged
Myelodysplastic Syndromes
Prognosis
Proportional Hazards Models
Transplantation, Homologous