Poor pretransplantation minimal residual disease clearance as an independent prognostic risk factor for survival in myelodysplastic syndrome with excess blasts: A multicenter, retrospective cohort study

Abstract

Background Minimal residual disease (MRD) is an important prognostic factor for survival in adults with acute leukemia. The role of pretransplantation MRD status in myelodysplastic syndrome with excess blasts (MDS‐EB) is unknown. This study retrospectively analyzed the relationship between pretransplantation MRD status and long‐term survival. Materials and Methods Patients with MDS‐EB who underwent allogeneic hematopoietic stem cell transplantation (allo‐HSCT) from March 5, 2005, to November 8, 2020, were included. The relationship between pretransplantation MRD status and long‐term survival was analyzed using univariate and multivariate logistic regression models. Results Of 220 patients with MDS‐EB who underwent allo‐HSCT, 198 were eligible for inclusion in this multicenter, retrospective cohort study. Complete remission was attained in 121 (61.1%) patients, and 103 patients underwent detection of MRD pretransplantation, with 67 patients being MRD‐positive and 36 patients being MRD‐negative. The median follow‐up time was 16 months, the median age was 41 years (6–65 years), and 58% of the patients were men. The 3‐year disease‐free survival (DFS) and overall survival (OS) probabilities for all patients were 70.1% and 72.9%, respectively. For patients in complete remission, the 3‐year DFS and OS probabilities were 72.2% and 74.8%, respectively. Further analysis found that the 3‐year DFS rates of MRD‐negative and MRD‐positive patients were 85.6% and 66.5% (p = .045), respectively, whereas the 3‐year OS rates were 91.3% and 66.4% (p = .035), respectively. Univariate and multivariate analyses showed that poor pretransplantation MRD clearance was an independent prognostic risk factor for DFS and OS. Conclusion Poor pretransplantation MRD clearance is an independent prognostic risk factor for long‐term survival after allo‐HSCT for patients with MDS‐EB. Plain language summary Poor minimal residual disease clearance pretransplanation is an independent prognostic risk factor for long‐term survival after allogeneic hematopoietic stem cell transplantation for patients with myelodysplastic syndrome with excess blasts.

Impact of myelofibrosis on patients with myelodysplastic syndromes following allogeneic hematopoietic stem cell transplantation

“…In alignment with our study, it was revealed that patients with MDS who achieved CR before allo-HSCT had improved outcomes [ 14 ]. Recently, it was confirmed that pre-HSCT MRD positivity was an independent risk factor for transplant outcomes in patients with MRD with excess blasts, along with the 3-year OS rates of 91.3% and 66.4% in the MRD-negative and MRD-positive cohorts, respectively [ 32 ]. Remarkably, reducing tumor burden was recommended in patients with ≥ 10% BM blasts, especially when RIC was planned [ 33 ].…”

Relative prognostic value of flow cytometric measurable residual disease before allogeneic hematopoietic cell transplantation for adults with MDS/AML or AML

“…Specifically, while some disease entities with recurrent genetic abnormalities are now defined as AML, even in cases with less than 20% blasts, 17–19 a new category encompassing cases with 10%–19% blasts as “MDS/AML” has been introduced in the 2022 International Consensus Classification (ICC) to recognize the diagnostic continuum between MDS and AML 17,19 . Although the relative prognostic value of MFC‐based MRD testing has been evaluated in patients with MDS irrespective of blast counts, 20,21 it has not been formally analyzed in MDS/AML patients. Therefore, we here evaluated the relationship between pre‐HCT MFC‐based MRD and post‐HCT outcomes by examining a large cohort of adults with MDS/AML or AML who underwent allogeneic HCT in first or second morphologic remission at a single institution between April 2006 and March 2023.…”

The role of MSCs and CAR-MSCs in cellular immunotherapy

“…The most common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is graft-versus-host disease (GVHD), which is also a cause of death or low quality of life [ 148 – 151 ]. MSCs have been extensively used in clinics, especially for GVHD prevention and treatment [ 152 , 153 ].…”