Prognostic Scoring System for Patients Undergoing Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome
As reported in the Journal of Clinical Oncology, Shaffer et al have developed a prognostic scoring system for patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome.
Study Details
The study involved data from 2,133 patients with myelodysplastic syndrome in the Center for International Blood and Marrow Transplant Research (CIBMTR) registry who underwent HLA-matched (n = 1,728) or HLA-mismatched (n = 405) allogeneic hematopoietic cell transplantation between 2000 and 2012. A Cox multivariable model was used to identify factors prognostic for mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using the identified factors was assigned to the remaining patients undergoing HLA-matched allogeneic hematopoietic cell transplantation (validation cohort; n = 577) and to the patients undergoing HLA-mismatched allogeneic hematopoietic cell transplantation.
Scoring System
Blood blasts > 3% (hazard ratio [HR] = 1.41, 95% confidence interval [CI] = 1.08–1.85), platelets ≤ 50 × 109/L at transplantation (HR = 1.37, 95% CI = 1.18–1.61), Karnofsky performance status < 90% (HR = 1.25, 95% CI = 1.06–1.28), comprehensive cytogenetic risk score of poor or very poor (HR = 1.43, 95% CI = 1.14–1.80), and age 30 to 49 years (HR = 1.60, 95% CI = 1.09–2.35) were associated with increased risk of death and were assigned 1 point in the scoring system, whereas monosomal karyotype (HR = 2.01, 95% CI = 1.65–2.45) and age ≥ 50 years (HR = 1.93, 95% CI, 1.36–2.83) were assigned 2 points.
HLA-Matched Cohorts
In the HLA-matched validation cohort, 3-year overall survival after hematopoietic cell transplantation was 71% (95% CI = 58%–85%) in patients with scores of 0 to 1 (low), 49% (95% CI = 42%–56%; HR = 1.66, P = .045, vs low) for scores of 2 to 3 (intermediate), 41% (95% CI = 31%–51%; HR = 2.29, P = .002, vs low) for scores of 4 to 5 (high), and 25% (95% CI = 4%–46%; HR = 5.02, P < .001, vs low) for scores ≥ 6 (very high; overall P < .001).
For the combined HLA-matched cohorts, higher scores were associated with worse outcome for relapse (HRs = 2.09, 3.71, and 7.49, vs low, overall P < .001), treatment-related mortality (HRs = 1.40, 1.92, and 4.43, vs low, overall P < .001), and disease-free survival (HRs = 1.63, 2.53, and 5.47, vs low, overall P < .001).
HLA-Mismatched Cohort
The prognostic score was associated with risk of relapse in the HLA-mismatched cohort (P = .04) but not with treatment-related mortality (P = .82), disease-free survival (P = .21), or overall survival (P = .13).
The investigators concluded: “The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched [allogeneic] hematopoietic cell transplantation for myelodysplastic syndrome.”
The CIBMTR is supported by the National Cancer Institute and many others.
Brian C. Shaffer, MD, of Memorial Sloan Kettering Cancer Center, New York, New York, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
