The prognosis of myelodysplastic syndromes (MDS) after allogeneic stem cell transplantation is critically determined by cytogenetic abnormalities, as previously defined by International Prognostic Scoring System (IPSS) cytogenetics. It has been shown that a new cytogenetic classification, included in the IPSS-R (cytogenetic-IPSS-R [C-IPSS-R]), can better predict the outcome of untreated MDS patients.
In this study, we assessed the impact of the IPSS-R cytogenetic score (C-IPSS-R) on the outcome of 367 MDS patients transplanted from HLA-identical siblings or HLA allele-matched unrelated donors.
According to the C-IPSS-R, 178 patients (48%) fell in the good risk, 102 (28%) in the intermediate risk, 77 (21%) in the poor risk, and 10 (3%) in the very poor risk group. In multivariate analysis, after a median follow-up of 4 years, the poor and very poor-risk categories correlated with shorter overall survival (OS) (4-year OS, 32%; hazard ratio [HR], 1.59; P = 0.009 and OS, 10%; HR, 3.18; P = 0.002, respectively) and higher cumulative incidence of relapse (CIR) (CIR, 52%; HR, 1.82; P = 0.004 and CIR, 60%; HR, 2.44; P = 0.060, respectively).
Overall, the C-IPSS-R changed the IPSS cytogenetic risk only in 8% of cases but identified a new risk group, the very poor C-IPSS-R category, with dismal outcome after allogeneic stem cell transplantation (10% 4-year OS, 60% 4-year CIR). Posttransplantation maintenance therapy should be investigated in prospective trials for patients with high-risk C-IPSS-R karyotypes.
In a French retrospective, multicenter study use of the revised International Prognostic Scoring System classification helps predict the outcome of untreated patients with a myelodysplastic syndrome, especially in the most severe cases.
1 CHRU Lille, Pôle Spécialités Médicales et Gérontologie, Service des Maladies du Sang, Secteur Allogreffe de Cellules Souches Hématopoïétiques, F59037, Lille, France.
2 Université de Lille, UFR Médecine F59000, Lille, France.
3 Hematology Department, Caen University Hospital, Amiens, France.
4 Department of Biostatistics, Lille University Hospital, Lille, France.
5 Hematology Department and Hematopoietic Stem Cell Transplantation Unit, Saint-Louis Hospital, Paris, France.
6 Hematology Department, Lyon-Sud Hospital, Lyon, France.
7 Hematology Department, Nantes, France.
8 Hematology Department CH-Liège, Liège, Belgium.
9 Hematology Department, Pitié-Salpêtrière Hospital, Paris, France.
10 Hematology Department, Strasbourg University Hospital, Strasbourg, France.
11 Hematopoietic Stem Cell Transplantation Unit, Paoli Calmettes Institute, Marseille, France.
12 Hematology Department, Loire Oncology Institute (ICL), Saint Priest en Jarez, France.
13 Hematology Department, Nantes University Hospital, Nantes, France.
14 Hematology Department, Saint-Antoine Hospital, Paris, France.
15 Hematology Department, Toulouse University Hospital, Toulouse, France.
16 Hematology Department, Grenoble University Hospital, Grenoble, France.
17 Hematology Department, Bordeaux University Hospital, Bordeaux, France.
Received 7 September 2014. Revision requested 5 November 2014.
Accepted 31 October 2014.
The authors declare no conflict of interest.
This study was presented, in part at the French Society of Bone Marrow Trans-plantation and Cell Therapy (SFGM-TC) annual meeting, November 8–11, 2013, Lyon, France and at the European Bone Marrow Transplantation Congress, April 1–3, 2014, Milan, Italy.
J.G. participated in research design, in the writing of the paper and in data analysis. G.D. participated in the writing of the paper and in data analysis. C.L. participated in data analysis, M.R., M.M., P.C. Y.B., S.N., P.B., D.B.,, J.C., A.C., M.M., A.H., A.T.-B., S.V., and A.D. participated in the writing of the paper and in the performance of the research. I.Y.-A. participated in the research design, in the writing of the paper and in the performance of the research.
Correspondence: Ibrahim Yakoub-Agha, MD, PhD, UAM allogreffes de CSH, CHRU Lille, F-59037 Lille CEDEX, France. (Ibrahim.email@example.com).