Specific abnormalities versus number of abnormalities and cytogenetic scoring systems for outcome prediction after allogeneic hematopoietic SCT for myelodysplastic syndromes

Abstract

Newer cytogenetic scoring systems for myelodysplastic syndromes (MDSs), like cytogenetic stratification of the revised international prognostic scoring system (IPSS-R) or monosomal karyotype, may also improve outcome prediction after hematopoietic SCT (HCT). We compared the prognostic value of specific cytogenetic abnormalities, IPSS-R karyotype and monosomal karyotype for HCT outcome in 98 patients with MDS and AML post MDS. Higher-risk IPSS-R karyotype, 3q21q26 and transformation to AML before HCT were associated with increased cumulative incidence of relapse (CIR), whereas OS was adversely influenced by del 5q/−5, abnormalities of chromosomes 11 and 17 and cytogenetic IPSS-R very poor category. Karyotype with ⩽ 2 abnormalities and no abnormalities of chromosomes 3, 5, 7, 11 and 17 was an independent prognostic factor of lower CIR (hazard ratio (HR) = 0.2, P = 0.01) and longer OS (HR = 0.5, P = 0.03). In conclusion, some specific cytogenetic abnormalities and high cytogenetic complexity, as reflected by IPSS-R very poor karyotype, rather than monosomal karyotype, were associated with higher CIR and shorter OS after HCT. Conversely, results were encouraging in patients lacking those abnormalities, who may be very good candidates for HCT.

Prognostic impact of chromosomal translocations in myelodysplastic syndromes and chronic myelomonocytic leukemia patients. A study by the spanish group of myelodysplastic syndromes

“…Their strong association with complex karyotypes and higher number of chromosomal alterations might be the expression of an inherent chromosomal instability that facilitates disease progression. Indeed, it is well known that both complex karyotypes and high number of chromosomal alterations confer an adverse prognosis (Morel et al, 1993;Greenberg et al, 1997;Schanz et al, 2012;Kelaidi et al, 2014). A proper prognostic stratification in MDS is essential for designing risk-adapted therapeutic strategies that can range from watchful waiting to allogeneic hematopoietic stem cell transplantation.…”

Relapse after Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes: Analysis of Late Relapse Using Comparative Karyotype and Chromosome Genome Array Testing

“…However, emerging information suggests that disease clones responsible for relapse after HCT often differ from those identified before HCT [15], although the presentation at late relapse is not well defined. We analyzed relapse patterns in 1007 patients who underwent transplantation for MDS in an attempt to identify factors that may determine “early” versus “late” relapse.…”

Prognostic significance of monosomal karyotype in myelodysplastic syndrome: a meta-analysis

“…But in the study conducted by Schanz et al [13] MK was associated with inferior OS in patients with ≤4 abnormalities only, not in highly complex karyotypes (≥5 abnormalities). In other studies, MK demonstrated negative impact on OS but was not identified as an independent risk factor [14][15][16]. MK is considerably overlapped with complex karyotype (CK, defined as at least three cytogenetic abnormalities).…”

“…After carefully reading the full texts, 13 studies were excluded due to insufficient data. Finally, 17 studies, [8][9][10][11][12][13][14][15][16][17][18][19][20][25][26][27][28] including a letter to the editor [18] were included in this meta-analysis.…”

“…The study conducted by Xing et al [9] included 610 patients, however, followup data were only available in 390 patients who received nonintensive therapies and extracted for this meta-analysis. Of the 17 eligible studies, 5 studies were from North America, [17,[25][26][27][28] 5 from Europe, [13,14,[16][17][18] 6 from Asia, [9,11,12,15,19,20] 1 from Oceania [10]. The median age in 6 studies was over 60 years, [10,[13][14][15]17,19] in 7 studies under 60 years, [11,12,16,20,[25][26][27] and in 4 studies not available [8,9,18,28].…”