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

Authors: 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.; Valc√°rcel, D.; Grunwald, M. R.; Fasan, O.; Copelan, E.; Wood, W. A.; Rizzieri, D. A.; Bacher, U.; Hamilton, B.; Gerds, A.; Kalaycio, M.; Sobecks, R.; William, B.; Saad, A.; Costa, L. J.; Cutler, C.; Alyea, E.; Warlick, E.; Ustun, C.; Wirk, B. M.; Sabloff, M.; Daly, A.; Marks, D.; Gale, R. P.; Olsson, R.; Miller, A. M.; Kamble, R.; Cortes, J.; Popat, U.; Kindwall-Keller, T. L.; Cahn, J. Y.; Savani, B. N.; Vij, R.; Maziarz, R.; Pavletic, S.
Article Title: Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome
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. © 2016 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 16
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-06-01
Start Page: 1864
End Page: 1871
Language: English
DOI: 10.1200/jco.2015.65.0515
PROVIDER: scopus
PUBMED: 27044940
PMCID: PMC4966345
Notes: Article -- Export Date: 1 July 2016 -- Source: Scopus
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MSK Authors
  1. Martin Stuart Tallman
    408 Tallman
  2. Brian Carl Shaffer
    42 Shaffer