A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome

Cutler, Corey; Lee, Stephanie J.; Greenberg, Peter L.; Deeg, H. Joachim; Pérez, Waleska S.; Anasetti, Claudio; Bolwell, Brian J.; Cairo, Mitchell S.; Gale, Robert Peter; Klein, John P.; Lazarus, Hillard M.; Liesveld, Jane L.; McCarthy, Philip L.; Milone, Gustavo; Rizzo, J. Douglas; Schultz, Kirk R.; Trigg, Michael E.; Keating, Armand; Weisdorf, Daniel J.; Antin, Joseph H.; Horowitz, Mary M.

doi:10.1182/blood-2004-01-0338

Cited by 618 publications

(398 citation statements)

References 40 publications

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“…Though most patients only received palliative care, some did receive allogeneic HSCT or HMA, which gave us a chance to investigate the impact of IPSS-R on patients undergoing different treatment modalities. Allogeneic HSCT is recommended in patients with IPSS Int-2 and high risk diseases [20,21] and HMA is suggested in intermediate-and high-risk patients [22,23]. Nevertheless, it is unclear which risk group, based on IPSS-R classification, will get benefits from allogeneic HSCT or HMA.…”

Section: Discussionmentioning

confidence: 99%

IPSS‐R in 555 Taiwanese patients with primary MDS: Integration of monosomal karyotype can better risk‐stratify the patients

et al. 2014

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The revised International Prognostic Scoring System (IPSS-R) was recently developed to better assess the clinical outcome of adult patients with myelodysplastic syndrome (MDS). In this study, we aimed to investigate the prognostic impact of this new risk model on 555 MDS patients in Taiwan. Generally, the IPSS-R could discriminate MDS patients regarding risk of leukemia evolution and overall survival in our cohort and it further refined prognostic stratification in all IPSS risk categories. However, we could not find the intergroup difference between IPSS-R very low and low risk subgroups in both leukemia-free survival (LFS) and overall survival (OS). IPSS-R couldn't distinguish the prognosis between very good and good and between good and intermediate risk cytogenetic categories in OS, and between very good and good and between intermediate and poor cytogenetic-risk categories in LFS, either. On the other hand, incorporation of monosomal karyotype (MK) into IPSS-R could further stratify MDS patients with higher-risk IPSS-R (intermediate, high and very high risk) into four groups, rather than three groups, with different OS (P < 0.001). Intriguingly, patients receiving allogeneic hematopoietic stem cell transplantation had longer survival than those without in the IPSS-R high and very high, but not other risk groups. Similarly, patients treated with hypomethylating agents had better survival than those not in the IPSS-R very high risk group. In conclusion, IPSS-R can risk-stratify MDS patients in Taiwan but with some limitations, especially in very low risk category, and MK has additional prognostic value in discriminating MDS patients with higher-risk IPSS-R.

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Section: Discussionmentioning

confidence: 99%

IPSS‐R in 555 Taiwanese patients with primary MDS: Integration of monosomal karyotype can better risk‐stratify the patients

et al. 2014

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“…Physicians must take into account this risk pattern when making critical treatment decisions, such as whether and when to suggest hematopoietic stem cell transplantation (HSCT), as is done in other high risk premalignant conditions [15]. Currently, HSCT, although highly toxic, is the only curative treatment that can prevent MDS from deteriorating to sAML [16], but studies, examining an optimal HSCT timing for patients with MDS, vary in their conclusions [17,18]. A statistical model, assuming constant risk of transformation, proposes delaying transplantation to improve survival [17], whereas early transplantation has been recommended based on the observations that patients with MDS who underwent HSCT relatively late, had shorter overall survival [18].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, HSCT, although highly toxic, is the only curative treatment that can prevent MDS from deteriorating to sAML [16], but studies, examining an optimal HSCT timing for patients with MDS, vary in their conclusions [17,18]. A statistical model, assuming constant risk of transformation, proposes delaying transplantation to improve survival [17], whereas early transplantation has been recommended based on the observations that patients with MDS who underwent HSCT relatively late, had shorter overall survival [18]. Therefore, elucidating the pattern of the sAML transformation risk since MDS diagnosis may have an important impact on the decisions about HSCT timing.…”

Section: Introductionmentioning

confidence: 99%

Analyzing transformation of myelodysplastic syndrome to secondary acute myeloid leukemia using a large patient database

et al. 2012

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One‐third of patients with myelodysplastic syndrome (MDS) progress to secondary acute myeloid leukemia (sAML), with its concomitant poor prognosis. Recently, multiple mutations have been identified in association with MDS‐to‐sAMLtransition, but it is still unclear whether all these mutations are necessary for transformation. If multiple independent mutations are required for the transformation, sAML risk should increase with time from MDS diagnosis. In contrast, if a single critical biological event determines sAML transformation; its risk should be constant in time elapsing from MDS diagnosis. To elucidate this question, we studied a database of 1079 patients with MDS. We classified patients according to the International Prognostic Scoring System (IPSS), using either the French‐American‐British (FAB) or the World Health Organization (WHO) criteria, and statistically analyzed the resulting transformation risk curves of each group. The risk of transformation after MDS diagnosis remained constant in time within three out of four risk groups, and in all four risk groups, when patients were classified according to FAB or to the WHO‐determined criteria, respectively. Further subdivision by blast percentage or cytogenetics had no influence on this result. Our analysis suggests that a single random biological event leads to transformation to sAML, thus calling for the exclusion of time since MDS diagnosis from the clinical decision‐making process. Am. J. Hematol. © 2012 Wiley Periodicals, Inc.

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“…Allogeneic hematopoietic stem cell transplantation (HSCT) is potentially curative with a reported disease-free survival (DFS) of 30-50% [4][5][6][7][8][9]. In MDS, HSCT is the only therapy known to improve survival [10]. For nearly a decade nonmyeloablative (MA) or reduced intensity (RI) HSCT has been explored as a means to ameliorate the intensity of the conditioning and decrease the transplant-related toxicity while retaining the graft versus leukemia effect.…”

Section: Introductionmentioning

confidence: 99%

Reduced intensity compared with high dose conditioning for allotransplantation in acute myeloid leukemia and myelodysplastic syndrome: A comparative clinical analysis

et al. 2007

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We evaluated the efficacy of hematopoietic stem cell transplantation (HSCT) using reduced intensity (RI) vs. myeloablative (MA) conditioning for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome. Thirty two patients (median age 54) who underwent a RI HSCT (2000HSCT ( -2003 were compared with 187 patients (median age 39) who received a MA transplant (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). Neutrophil engraftment was more rapid in the RI group (median 11.5 vs. 21 days). Platelet recovery was similar and graft failure was infrequent. The incidence of graft-versus-host disease (GVHD) and treatment-related mortality was similar though relapse was more frequent after RI conditioning (RR 2.2 [95% CI 5 1.1-4.6] P 5 0.03). At 2 years, disease-free survival (DFS) (31% vs. 30%, P > 0.1) and overall survival (33% vs. 35%, P > 0.1) were comparable between RI and MA groups, respectively. We suggest that RI allografts can yield satisfactory DFS both for older as well as younger patients with pre-existing comorbidities, who are ineligible for MA allografts. Advances in GVHD management and new approaches for relapsed or refractory disease are necessary to improve these outcomes. Am. J. Hematol. 82:867-872, 2007. V

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A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome

Cited by 618 publications

References 40 publications

IPSS‐R in 555 Taiwanese patients with primary MDS: Integration of monosomal karyotype can better risk‐stratify the patients

IPSS‐R in 555 Taiwanese patients with primary MDS: Integration of monosomal karyotype can better risk‐stratify the patients

Analyzing transformation of myelodysplastic syndrome to secondary acute myeloid leukemia using a large patient database

Reduced intensity compared with high dose conditioning for allotransplantation in acute myeloid leukemia and myelodysplastic syndrome: A comparative clinical analysis

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