IPSS poor-risk karyotype as a predictor of outcome for patients with myelodysplastic syndrome following myeloablative stem cell transplantation

Autor: John D. Shepherd, Heather J. Sutherland, Michael J. Barnett, Clayton A. Smith, Yasser Abou Mourad, Maryse M. Power, Stephen H. Nantel, Janet Nitta, Yunfeng Dai, Thomas J. Nevill, Donna E. Hogge, Kevin W. Song, Julye C. Lavoie, Cynthia L. Toze, Donna L. Forrest
Rok vydání: 2008
Předmět:
Adult
Male
medicine.medical_specialty
Transplantation Conditioning
Adolescent
medicine.medical_treatment
Blood stem cell transplantation
Hematopoietic stem cell transplantation
Gastroenterology
Young Adult
Predictive Value of Tests
Risk Factors
Internal medicine
hemic and lymphatic diseases
medicine
Humans
Survival analysis
Bone Marrow Transplantation
Retrospective Studies
Transplantation
Peripheral Blood Stem Cell Transplantation
business.industry
Myelodysplastic syndromes
Hematopoietic Stem Cell Transplantation
Retrospective cohort study
Hematology
Middle Aged
medicine.disease
Prognosis
Survival Analysis
Confidence interval
Treatment Outcome
Predictive value of tests
Karyotyping
Myelodysplastic Syndromes
Cohort
Immunology
Cytogenetic Analysis
Multivariate Analysis
Female
business
Myelodysplastic syndrome
Poor-risk karyotype
Zdroj: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 15(2)
ISSN: 1523-6536
Popis: The optimal therapy for myelodysplastic syndrome (MDS) is allogeneic bone marrow (BM) or blood (BSC) stem cell transplantation (SCT), although outcomes are limited by nonrelapse mortality (NRM) and relapse. A retrospective review was performed of 156 patients who underwent SCT (114 BM, 42 BSC) for MDS or secondary acute myelogenous leukemia (sAML) at our institution. Fifty-five patients remain in continuous complete remission: 35 BM recipients and 20 BSC recipients (median follow-up 139 and 89 months, respectively). Estimated 7-year event-free survival (EFS), NRM, and risk of relapse (ROR) are 33% (95% confidence intervals [CI] 25%-43%), 42% (CI 33%-51%), and 25% (CI 17%-33%) for the BM cohort and 45% (CI 32%-64%, P = .07), 32% (CI 18%-47%, P = .15), and 23% (CI 11%-37%, P = .79) for the BSC cohort. Multivariate analysis showed IPSS poor-risk cytogenetics (P < .001), time from diagnosis to SCT (P < .001), FAB subgroup (P = .001), recipients not in complete remission (CR1) at SCT (P = .005), and the development of acute graft-versus-host disease (aGVHD) (P = .04) were all predictive of an inferior EFS. The FAB subgroup (P = .002), poor-risk karyotype (P = .004), and non-CR1 status also correlated with ROR in multivariate analysis. EFS for poor-risk karyotype patients was superior after receiving BSC compared to BM (39% versus 6%, P < .001). SCT outcomes in MDS/sAML are strongly associated with the IPSS cytogenetic risk group, although the use of BSC in poor-risk karyotype patients may lead to a more favorable long-term EFS.
Databáze: OpenAIRE
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