Role of Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem-Cell Transplantation in Older Patients With De Novo Myelodysplastic Syndromes: An International Collaborative Decision Analysis

Koreth, John; Pidala, Joseph; Pérez, Waleska S.; Deeg, H. Joachim; Garcia‐Manero, Guillermo; Malcovati, Luca; Cazzola, Mario; Park, Sophie; Itzykson, Raphaël; Adès, Lionel; Fenaux, Pierre; Jädersten, Martin; Hellström‐Lindberg, Eva; Gale, Robert Peter; Beach, C. L.; Lee, Stephanie J.; Horowitz, Mary M.; Greenberg, Peter L.; Tallman, Martin S.; DiPersio, John F.; Bunjes, Donald; Weisdorf, Daniel J.; Cutler, Corey

doi:10.1200/jco.2012.46.8652

Cited by 260 publications

(190 citation statements)

References 52 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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“…Using a Markov model, the investigators analyzed the impact of reduced intensity transplant in older patients with MDS. Patients with lower risk disease did not appear to benefit from this less toxic transplant approaches [48].…”

Section: Allogeneic Stem Cell Transplantationmentioning

confidence: 99%

Myelodysplastic syndromes: 2012 update on diagnosis, risk‐stratification, and management

Garcia‐Manero

2012

American J Hematol

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Disease Overview: The myelodysplastic (MDS) are a very heterogeneous group of myeloid disorders characterized by peripheral blood cytopenias and increased risk of transformation to acute myelogenous leukemia (AML). MDS occurs more frequently in older male and in individuals with prior exposure to cytotoxic therapy.Diagnosis: Diagnosis of MDS is based on morphological evidence of dysplasia upon visual examination of a bone marrow aspirate and biopsy. Information obtained from additional studies such as karyotype, flow cytometry or molecular genetics is complementary but not diagnostic.Risk‐stratification: Prognosis of patients with MDS can be calculated using a number of scoring systems. In general, all these scoring systems include analysis of peripheral cytopenias, percentage of blasts in the bone marrow and cytogenetic characteristics. The most commonly used system is the International Prognostic Scoring System. IPSS is likely to be replaced by a new revised score (IPSS‐R) and by the incorporation of new molecular markers recently described.Risk‐adapted therapy: Therapy is selected based on risk, transfusion needs, percent of bone marrow blasts, and, more recently, cytogenetic profile. Goals of therapy are different in lower risk patients than in higher risk. In lower risk, the goal is to decrease transfusion needs and transformation to higher risk disease or AML. In higher risk, the goal is to prolong survival. Current available therapies include growth factor support, lenalidomide, hypomethylating agents, intensive chemotherapy, and allogeneic stem cell transplantation. The use of lenalidomide has significant clinical activity in patients with lower risk disease, anemia and a chromosome 5 alteration. 5‐azacitidine and decitabine have activity in higher risk MDS. 5‐azacitidine has been shown to improve survival in higher risk MDS. A number of new molecular lesions have been described in MDS that may serve as new therapeutic targets or aid in the selection of currently available agents. Additional supportive care measures may include the use of prophylactic antibiotics and iron chelation.Management of progressive or refractory disease: At the present time there are no approved interventions for patients with progressive or refractory disease particularly after hypomethylating based therapy. Options include cytarabine based therapy, transplantation and participation on a clinical trial. Am. J. Hematol. 87:692–701, 2012. © 2012 Wiley Periodicals, Inc.

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“…In previous decision analyses regarding hematologic diseases and HCT, [28][29][30][31][32] QOL estimates were determined by physicians. Therefore, the QOL-adjusted life expectancies demonstrated in these studies may not accurately reflect the QOL that patients themselves experience.…”

Section: Introductionmentioning

confidence: 99%

Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia

Kurosawa¹,

Yamaguchi

Mori

et al. 2015

Bone Marrow Transplant

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When discussing treatment options for patients with acute leukemia, it is important to acknowledge the impact of allogeneic hematopoietic cell transplantation (allo-HCT) or chemotherapy on quality of life (QOL). We performed a cross-sectional questionnaire study that administered SF-36, FACT-Leukemia and EuroQOL5D to 524 acute leukemia survivors, to compare patientreported QOL between chemotherapy and allo-HCT, and to elucidate predictors of QOL. Patients who received chemotherapy alone had a better physical QOL than those who received allo-HCT. On the other hand, the allo-HCT group reported a better mental QOL. In the comparison of QOL in the allo-HCT patients according to the presence of GVHD at survey, patients who had GVHD symptoms experienced statistically and clinically significantly worse QOL than those who did not. In the allo-HCT patients without GVHD, the physical QOL was comparable to that in the chemotherapy patients, and they experienced significantly better mental and general QOL than the chemotherapy patients. GVHD and immunosuppressive drugs at survey were strongly associated with worse QOL after allo-HCT. In the chemotherapy group, a shorter time between treatment completion and survey was significantly associated with worse QOL. Further evaluation of QOL by a longitudinal assessment with quantitative and qualitative analyses are warranted.

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Role of Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem-Cell Transplantation in Older Patients With De Novo Myelodysplastic Syndromes: An International Collaborative Decision Analysis

Abstract: For patients with de novo MDS aged 60 to 70 years, favored treatments vary with IPSS risk. For low/intermediate-1 IPSS, nontransplantation approaches are preferred. For intermediate-2/high IPSS, RIC transplantation offers overall and quality-adjusted survival benefit.

Cited by 260 publications

References 52 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

Myelodysplastic syndromes: 2012 update on diagnosis, risk‐stratification, and management

Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia

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