Novel disease burden assessment predicts allogeneic transplantation outcomes in myelodysplastic syndrome

B. J. Trottier, Zohar Sachs, Todd E De For, L. Shune, Michelle M Dolan, Daniel J Weisdorf, Celalettin Ustun, Erica D Warlick

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Among patients with myelodysplastic syndrome (MDS) undergoing hematopoietic cell transplantation (HCT), the impact of residual pretransplant cytogenetically abnormal cells on outcomes remains uncertain. We analyzed HCT outcomes by time of transplant disease variables, including (1) blast percentage, (2) percentage of cytogenetically abnormal cells and (3) Revised International Prognostic Scoring System (R-IPSS) cytogenetic classification. We included 82 MDS patients (median age 51 years (range 18-71)) transplanted between 1995 and 2013 with abnormal diagnostic cytogenetics. Patients with higher percentages of cytogenetically abnormal cells experienced inferior 5-year survival (37-76% abnormal cells: relative risk (RR) 2.9; 95% confidence interval (CI) 1.2-7.2; P=0.02; and 77-100% abnormal cells: RR 5.6; 95% CI 1.9-19.6; P<0.01). Patients with >10% blasts also had inferior 5-year survival (RR 2.9; 95% CI 1.1-7.2; P=0.02) versus patients with ≤2% blasts. Even among patients with ≤2% blasts, patients with 77-100% cytogenetically abnormal cells had poor survival (RR 4.4; 95% CI 1.1-18.3; P=0.04). Increased non-relapse mortality (NRM) was observed with both increasing blast percentages (P<0.01) and cytogenetically abnormal cells at transplant (P=0.01) in multivariate analysis. We observed no impact of disease burden characteristics on relapse outcomes due to high 1-year NRM. In conclusion, both blast percentage and percentage of cytogenetically abnormal cells reflect MDS disease burden and predict post-HCT outcomes.

Original languageEnglish (US)
Pages (from-to)199-204
Number of pages6
JournalBone marrow transplantation
Volume51
Issue number2
DOIs
StatePublished - Feb 1 2016

Bibliographical note

Funding Information:
This study received funding from the National Institute of Health T32 Training Grant (to BJT and ZS). This work was supported in part by grants from the National Cancer Institute P01 CA65493 (to TED).

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