1. Contribution of Revised International Prognostic Scoring System Cytogenetics to Predict Outcome After Allogeneic Stem Cell Transplantation for Myelodysplastic Syndromes: A Study From the French Society of Bone Marrow Transplantation and Cellular Therapy.
- Author
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Gauthier J, Damaj G, Langlois C, Robin M, Michallet M, Chevallier P, Beguin Y, N'guyen S, Bories P, Blaise D, Cornillon J, Clavert A, Mohty M, Huynh A, Thiébaut-Bertrand A, Vigouroux S, Duhamel A, and Yakoub-Agha I
- Subjects
- Belgium, Female, France, HLA Antigens immunology, Histocompatibility, Humans, Kaplan-Meier Estimate, Living Donors, Male, Middle Aged, Multivariate Analysis, Myelodysplastic Syndromes diagnosis, Myelodysplastic Syndromes immunology, Myelodysplastic Syndromes mortality, Predictive Value of Tests, Proportional Hazards Models, Recurrence, Retrospective Studies, Risk Assessment, Risk Factors, Siblings, Societies, Medical, Time Factors, Transplantation, Homologous, Treatment Outcome, Unrelated Donors, Cytogenetic Analysis, Decision Support Techniques, HLA Antigens genetics, Myelodysplastic Syndromes genetics, Myelodysplastic Syndromes surgery, Stem Cell Transplantation adverse effects, Stem Cell Transplantation methods, Stem Cell Transplantation mortality
- Abstract
Background: The prognosis of myelodysplastic syndromes (MDS) after allogeneic stem cell transplantation is critically determined by cytogenetic abnormalities, as previously defined by International Prognostic Scoring System (IPSS) cytogenetics. It has been shown that a new cytogenetic classification, included in the IPSS-R (cytogenetic-IPSS-R [C-IPSS-R]), can better predict the outcome of untreated MDS patients., Methods: In this study, we assessed the impact of the IPSS-R cytogenetic score (C-IPSS-R) on the outcome of 367 MDS patients transplanted from HLA-identical siblings or HLA allele-matched unrelated donors., Results: According to the C-IPSS-R, 178 patients (48%) fell in the good risk, 102 (28%) in the intermediate risk, 77 (21%) in the poor risk, and 10 (3%) in the very poor risk group. In multivariate analysis, after a median follow-up of 4 years, the poor and very poor-risk categories correlated with shorter overall survival (OS) (4-year OS, 32%; hazard ratio [HR], 1.59; P = 0.009 and OS, 10%; HR, 3.18; P = 0.002, respectively) and higher cumulative incidence of relapse (CIR) (CIR, 52%; HR, 1.82; P = 0.004 and CIR, 60%; HR, 2.44; P = 0.060, respectively)., Conclusions: Overall, the C-IPSS-R changed the IPSS cytogenetic risk only in 8% of cases but identified a new risk group, the very poor C-IPSS-R category, with dismal outcome after allogeneic stem cell transplantation (10% 4-year OS, 60% 4-year CIR). Posttransplantation maintenance therapy should be investigated in prospective trials for patients with high-risk C-IPSS-R karyotypes.
- Published
- 2015
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