Change in IPSS-R between diagnosis and transplant and transplant outcome in patients with MDS. a retrospective analysis from the chronic malignancies working party.
Scheid, C. Eikema, D. J. Niittyvuopio, R. Maertens, J. Passweg, J. Blaise, D. Byrne, J. Kroger, N. Bornhauser, M. Chevallier, P.
Scheid, C.
Eikema, D. J.
Niittyvuopio, R.
Maertens, J.
Passweg, J.
Blaise, D.
Byrne, J.
Kroger, N.
Bornhauser, M.
Chevallier, P.
Citations
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Abstract
Background: IPSS-R is a well established prognostic factor
for transplant outcome in patients with MDS, irrespective
whether it is assessed at diagnosis or at transplant. However
it is unclear how a change in IPSS-R, e.g. by reducing bone
marrow blasts through therapy, would potentially affect
transplant results. In particular the decision to treat patients
before transplant or perform an upfront allogeneic transplantation can so far not be based on evidence.
Methods: From the EBMT registry patients with MDS
and sufficient data to calculate IPSS-R at diagnosis and
before transplant were identified from the period 2005 -
2018.
1482 patients were analysed. Median age was 59
(interquartile range 51-64) years, 60% were male, 40%
female. Donors were related in 36% and unrelated in 64%,
graft source was PBSC in 85% of cases. Conditioning was
standard dose in 33% and reduced intensity in 67%.
Results: IPSS-R both at diagnosis and at transplant had a
significant impact on OS and RFS. To investigate the effect
of a change in IPSS-R between diagnosis and transplant we
formed 3 subgroups: same IPSS-R, improved IPSS-R,
worsened IPSS-R. A change in IPSS-R was noted 77.5% of
patients with prior chemotherapy, 72% with prior HMA and
59.8% of untreated patients. Univariate analysis showed no significant difference in OS or RFS in patients with stable
IPSS-R compared to improved or worsened IPSS-R.
To analyse the effect of a change in IPSS-R in the context
of IPSS-R at diagnosis and type of therapy between
diagnosis and transplant (none, chemotherapy, HMA, other)
a multivariable Cox regression for OS and RFS was
performed. From this model the predicted OS at 2yrs for
untreated patients with high risk IPSS-R at transplant was
63%, 57% and 65% for same, improved or worsened IPSS-R, respectively. With chemotherapy predicted 2yr OS was
35%, 59% and 32%, with HMA 46%, 48% and 19%, with
other treatments 2yr OS was 35%, 46% and 21% for same,
improved or worsened IPSS-R. RFS at 2 years in patients
with high-risk IPSS-R at diagnosis was predicted 55%, 49%
and 57% with no treatment, 31%, 54% and 31% after
chemotherapy, 41%, 40% and 14% after HMA, and 36%,
40% and 15% after other therapies. Similar results were
obtained for the other IPSS-R risk categories.
Conclusions: In this retrospective analysis from a large
cohort of patients with MDS a change in IPSS-R between
diagnosis and transplant did not appear to affect OS and
RFS after transplant in patients with no intermittent
treatment. In treated patients worsening of IPSS-R had a
negative effect on OS and RFS. Improving IPSS-R after
therapy however did not show a positive effect on OS or
RFS. Thus for MDS patients receiving an allogeneic
transplantation our results provide no clear signal that prior
therapy improves transplant outcome.
Authors
Scheid, C.
Eikema, D. J.
Niittyvuopio, R.
Maertens, J.
Passweg, J.
Blaise, D.
Byrne, J.
Kroger, N.
Bornhauser, M.
Chevallier, P.
Bourhis, J. H.
Cornelissen, J. J.
Sengeloev, H.
Finke, J.
Snowden, J. A.
Gedde-Dahl, T.
Guyotat, D.
Schanz, U.
Patel, Amit
Koster, L.
de Wreede, L. C.
Hayden, P. J.
Onida, F.
Robin, M
Yakoub-Agha, I.
Eikema, D. J.
Niittyvuopio, R.
Maertens, J.
Passweg, J.
Blaise, D.
Byrne, J.
Kroger, N.
Bornhauser, M.
Chevallier, P.
Bourhis, J. H.
Cornelissen, J. J.
Sengeloev, H.
Finke, J.
Snowden, J. A.
Gedde-Dahl, T.
Guyotat, D.
Schanz, U.
Patel, Amit
Koster, L.
de Wreede, L. C.
Hayden, P. J.
Onida, F.
Robin, M
Yakoub-Agha, I.
Affiliation
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Scheid C, Eikema DJ, Niittyvuopio R, Maertens J, Passweg J, Blaise D, et al. Change In IPSS-R Between Diagnosis And Transplant And Transplant Outcome in Patients With MDS. A Retrospective Analysis From The Chronic Malignancies Working Party. Bone Marrow Transplantation. 2021;56(SUPPL 1):141-2.