This study establishes that allogeneic BCT results in quicker hematologic recovery but is associated with a higher occurrence of chronic graft-versus-host disease.

A careful prognostic evaluation of patients referred for high-dose therapy (HDT) is warranted to identify those who maximally benefit from HDT as well as those who clearly fail current HDT and are candidates for more innovative treatments. In a series of 110 patients with myeloma who received HDT as first-line therapy, times to event (disease progression and death) were studied through proportional hazard models, in relation to different prognostic factors, including a chromosome 13 fluorescence in situ hybridization (FISH) analysis using a D13S319 probe. ⌬13 was detected in 42 patients (38%). Follow-up time among surviving patients and survival time were 48 ؎ 3 and 51 ؎ 7 months, respectively (median ؎ SE). In the univariate analysis, ⌬13 was the most powerful adverse prognostic factor for all times to event, especially for the survival time (P < .0001) and was followed by ␤ 2 -microglobulin (␤ 2 m) levels 2.5 mg/L or higher (P ‫؍‬ .0001). The comparison of survival prognostic models including ␤ 2 m 2.5 mg/L or greater and another factor favored the ⌬13/␤ 2 m combination. In 22 patients (20%) with no unfavorable factor, the median survival time was not reached at 111 months. In contrast, among 55 patients (50%) with one unfavorable factor and 33 patients (30%) with 2 unfavorable factors, median survival times were 47.3 ؎ 4.6 months and 25.3 ؎ 3.2 months, respectively (P < .0001). We conclude that ⌬13, adequately detected by FISH analysis, is a very strong factor related to poor survival, especially when associated with a ␤ 2 m level of 2.5 mg/L or higher. Routine FISH ⌬13 assessment is strongly recommended for patients considered for HDT. (Blood. 2001;97:1566-1571)

Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.