Validation of the revised IPSS at transplant in patients with myelodysplastic syndrome/transformed acute myelogenous leukemia receiving allogeneic stem cell transplantation: a retrospective analysis of the EBMT chronic malignancies working party
: Scheid C, de Wreede L, van Biezen A, Koenecke C, Gohring G, Volin L, Maertens J, Finke J, Passweg J, Beelen D, Cornelissen JJ, Itala-Remes M, Chevallier P, Russell N, Petersen E, Milpied N, Espiga CR, Peniket A, Sierra J, Mufti G, Crawley C, Veelken JH, Ljungman P, Cahn JY, Alessandrino EP, de Witte T, Robin M, Kroger N
Publisher: NATURE PUBLISHING GROUP
: 2017
: Bone Marrow Transplantation
: BONE MARROW TRANSPLANTATION
: BONE MARROW TRANSPL
: 52
: 11
: 1519
: 1525
: 7
: 0268-3369
: 1476-5365
DOI: https://doi.org/10.1038/bmt.2017.171
: http://www.nature.com/articles/bmt2017171
: https://research.utu.fi/converis/portal/detail/Publication/27258050
The International Prognostic Scoring System has been revised (IPSS-R) to predict prognosis of patients with myelodysplastic syndromes at diagnosis. To validate the use of the IPSS-R assessed before transplant rather than at diagnosis we performed a retrospective analysis of the EBMT database. A total of 579 patients had sufficient information available to calculate IPSS-R at transplant. Median overall survival (OS) from transplant was significantly different according to IPSS-R: very low 23.6 months, low 55.0 months, intermediate 19.7 months, high 13.5 months, very high 7.8 months (P < 0.001). In a multivariate Cox model the following parameters were significant risk factors for OS: IPSS-R, graft source, age and prior treatment. Median relapse free survival also showed significant differences according to IPSS-R: very low: 23.6 months, low: 24.8 months, intermediate 10.6 months, high 7.9 months, very high 5.5 months (P < 0.001). Multivariate risk factors for relapse-free survival (RFS) were: IPSS-R, reduced intensity conditioning, graft source and prior treatment. A trend for an increased relapse incidence was noted for very high risk IPSS-R. We conclude that the IPSS-R at transplant is a useful prognostic score for predicting OS and RFS after transplantation, capturing both disease evolution and response to prior treatment before transplant.
