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Improving Revised International Prognostic Scoring System Pre-Allogeneic Stem Cell Transplantation Does Not Translate Into Better Post-Transplantation Outcomes for Patients with Myelodysplastic Syndromes: A Single-Center Experience.
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- Author(s): Alzahrani M;Alzahrani M;Alzahrani M; Power M; Power M; Power M; Abou Mourad Y; Abou Mourad Y; Abou Mourad Y; Barnett M; Barnett M; Barnett M; Broady R; Broady R; Broady R; Forrest D; Forrest D; Forrest D; Gerrie A; Gerrie A; Gerrie A; Hogge D; Hogge D; Hogge D; Nantel S; Nantel S; Nantel S; Sanford D; Sanford D; Sanford D; Song K; Song K; Song K; Sutherland H; Sutherland H; Sutherland H; Toze C; Toze C; Toze C; Nevill T; Nevill T; Nevill T; Narayanan S; Narayanan S; Narayanan S
- Source:
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2018 Jun; Vol. 24 (6), pp. 1209-1215. Date of Electronic Publication: 2018 Feb 20.- Publication Type:
Journal Article; Research Support, Non-U.S. Gov't- Language:
English - Source:
- Additional Information
- Source: Publisher: Carden Jennings Publishing Country of Publication: United States NLM ID: 9600628 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1523-6536 (Electronic) Linking ISSN: 10838791 NLM ISO Abbreviation: Biol Blood Marrow Transplant Subsets: MEDLINE
- Publication Information: Publication: Charlottesville, VA : Carden Jennings Publishing
Original Publication: Charlottesville, VA : Kluge Carden Jennings Publishing, Co., Ltd., [1995- - Subject Terms: Prognosis*; Hematopoietic Stem Cell Transplantation/*methods ; Myelodysplastic Syndromes/*diagnosis; Adolescent ; Adult ; Aged ; Blast Crisis/pathology ; Cell Count ; Female ; Hematopoietic Stem Cell Transplantation/mortality ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes/mortality ; Myelodysplastic Syndromes/pathology ; Myelodysplastic Syndromes/therapy ; Predictive Value of Tests ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Transplantation Conditioning/methods ; Transplantation, Homologous/methods ; Treatment Outcome
- Abstract: The natural history of patients with myelodysplastic syndromes (MDS) is variable. The Revised International Prognostic Score (IPSS-R) is commonly used in practice to predict outcomes in patients with MDS at both diagnosis and before hematopoietic stem cell transplantation (HSCT). However, the effect of change in the IPSS-R before allogeneic HSCT with chemotherapy or hypomethylating agents on post-transplantation outcomes is currently unknown. We assessed whether improvement in IPSS-R prognostic score pre-HSCT would result in improvement in clinical outcomes post-HSCT. Secondary goals included studying the effect of prognostic factors on post-transplantation survival. All patients with MDS who underwent allogeneic HSCT at the Leukemia/BMT Program of British Columbia between February 1997 and April 2013 were included. Pertinent information was reviewed from the program database. IPSS-R was calculated based on data from the time of MDS diagnosis and before HSCT. Outcomes of patients who had improved IPSS-R pre-HSCT were compared with those with stable or worse IPSS-R. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan-Meier method, with P values determined using the log-rank test. Hazard ratios were calculated using multivariable Cox proportional hazards regression models to study the effects of the prognostic variables on OS and EFS. A total of 138 consecutive patients were included. IPSS-R improved in 62 of these patients (45%), worsened in 23 (17%), remained stable in 41 (30%), and was unknown in 12 (9%). OS was not statistically different across the improved, worsened, and stable groups (30% versus 22% versus 40%, respectively; P = .63). The cumulative incidences of relapse and nonrelapse mortality at 5 years were 28.4% (95% confidence interval [CI], 21.1 to 36.1) and 31.6% (95% CI, 23.8 to 39.7), respectively. The rate of relapse was 23% in patients with <5% blasts at the time of HSCT, 69% in those with 5% to 20% blasts, and 66% in those with >20% blasts (P = .0004). In the entire cohort OS was 34% and EFS was 33%. There was no significant difference in outcomes between patients who received myeloablative conditioning and those who received nonmyeloablative conditioning before HSCT (OS, 34% and 39%, respectively; P = .63 and EFS, 34% and 32%, respectively; P = .86). OS was not statistically different among patients with improved, worsened, or stable IPSS-R. On multivariate analysis, only 3 factors were associated with OS: cytogenetic risk group at diagnosis, blast count at transplantation, and the presence or absence of chronic graft-versus-host disease. Improving IPSS-R before HSCT does not translate into better survival outcomes. Blast count pretransplantation was highly predictive of post-transplantation outcomes.
(Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.) - Contributed Indexing: Keywords: IPSS-R; Myelodysplastic syndromes; Revised international prognostic scoring system; Stem cell transplantation
- Publication Date: Date Created: 20180224 Date Completed: 20190401 Latest Revision: 20190401
- Publication Date: 20221213
- Accession Number: 10.1016/j.bbmt.2018.02.007
- Accession Number: 29474870
- Source:
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