Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome

Brian C. Shaffer, Martin Tallman, Adriana K. Malone, Ran Reshef, Mark Litzow, Jane Liesveld, Peter H. Wiernik, Kwang Woo Ahn, Zhen Huan Hu, Wael Saber, Taiga Nishihori, Mohamed A. Kharfan-Dabaja, David Valcárcel, Michael R. Grunwald, Omotayo Fasan, Edward Copelan, William Allen Wood, David A. Rizzieri, Ulrike Bacher, Betty HamiltonAaron Gerds, Matt Kalaycio, Ron Sobecks, Basem William, Ayman Saad, Luciano J. Costa, Corey Cutler, Edwin Alyea, Erica Warlick, Celalettin Ustun, Baldeep Mona Wirk, Mitchell Sabloff, Andrew Daly, David Marks, Robert Peter Gale, Richard Olsson, Alan M. Miller, Rammurti Kamble, Jorge Cortes, Uday Popat, Tamila L. Kindwall-Keller, Jean Yves Cahn, Bipin N. Savani, Ravi Vij, Richard Maziarz, Steven Pavletic

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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 3 109 /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 ([[ampi]]ge; 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 [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .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.

Original languageEnglish (US)
Pages (from-to)1864-1871
Number of pages8
JournalJournal of Clinical Oncology
Volume34
Issue number16
DOIs
StatePublished - Jun 1 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Shaffer, B. C., Tallman, M., Malone, A. K., Reshef, R., Litzow, M., Liesveld, J., Wiernik, P. H., Ahn, K. W., Hu, Z. H., Saber, W., Nishihori, T., Kharfan-Dabaja, M. A., Valcárcel, D., Grunwald, M. R., Fasan, O., Copelan, E., Wood, W. A., Rizzieri, D. A., Bacher, U., ... Pavletic, S. (2016). Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome. Journal of Clinical Oncology, 34(16), 1864-1871. https://doi.org/10.1200/JCO.2015.65.0515