Five-group cytogenetic risk classification, monosomal karyotype, and outcome after hematopoietic cell transplantation for MDS or acute leukemia evolving from MDS

Abstract

<jats:title>Abstract</jats:title><jats:p>Clonal cytogenetic abnormalities are a major risk factor for relapse after hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS). We determined the impact of the recently established 5-group cytogenetic classification of MDS on outcome after HCT. Results were compared with the impact of the International Prognostic Scoring System (IPSS) 3 cytogenetic risk groups, and the additional effect of a monosomal karyotype was assessed. The study included data on 1007 patients, 1-75 years old (median 45 years), transplanted from related (n = 547) or unrelated (n = 460) donors. Various conditioning regimens were used, and marrow, peripheral blood, or cord blood served as stem cell source. Both IPSS and 5-group cytogenetic risk classifications were significantly associated with post-HCT relapse and mortality, but the 5-group classification discriminated more clearly among the lowest- and highest-risk patients. A monosomal karyotype tended to further increase the rates of relapse and mortality, even after considering the IPSS or 5-group classifications. In addition, the pathologic disease category correlated with both relapse and mortality. Mortality was also impacted by patient age, donor type, conditioning regimen, platelet count, and etiology of MDS. Although mortality declined significantly in recent years, novel strategies are needed to overcome the barrier of high-risk cytogenetics.</jats:p>

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

“…We also assessed the predictive value of newer prognostic cytogenetic systems, that is, IPSS-R karyotype, including VPK, and MK. The proportion of patients with IPSS-R VPK and with MK was similar to that found in other MDS transplant series 10,11 (Table 6). Despite considerable overlap between VPK and MK and although we did not perform a formal comparison between the two cytogenetic groups, VPK was found to be more powerful than MK in predicting OS after HCT.…”

“…Disease status and cytogenetic classification, specifically poor-risk IPSS cytogenetic group, have been recognized as the most important disease-related determinants for outcome after HCT. [7][8][9][10][11] In this study, we focused on specific cytogenetic abnormalities as well as newer cytogenetic prognostic scores in the setting of HCT. The span of the series covered almost 20 years of HCT.…”

“…A prognostic impact of cytogenetics on outcome after HCT for MDS has been validated, but the role of newer cytogenetic scoring systems in that context is currently under investigation. [7][8][9][10][11] In this study, we analyzed the prognostic relevance of specific cytogenetic abnormalities, IPSS-R cytogenetic classification and monosomal karyotype in the setting of HCT for MDS and AML post MDS. Table 1.…”

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

“…Older patients usually have more resistant AML, higher incidence of MK and CK, and higher probability of death from therapy [13][14][15]. Reduced intensity conditioning (RIC) and nonmyeloablative conditioning (NMA) have been designed to decrease treatmentrelated mortality, allowing SCT in this group of patients as well as in those with comorbidities [16].…”

Comorbidity-Age Index: A Clinical Measure of Biologic Age Before Allogeneic Hematopoietic Cell Transplantation

“…During the past 50 years, major advances have been made in our understanding of the impacts of disease-specific risk factors (eg, chromosomal aberrations and gene expression profiles 1,2 ) and transplantation-specific risk factors (eg, the choice of donor grafts [3][4][5] or stem-cell source 6 ). On the other hand, until recently, age alone was the most widely used measure of a patient's ability to tolerate a given conditioning regimen for allogeneic HCT.…”