Authors:
S. Hashmi, E. S. Rich, S. Basu, J. J. Maciejewski, S. Nathan, P. Venugopal, S. A. Gregory, H. C. Fung, & J. M. Shammo
Summary:
Background - AlloHCT remains the only curative option for pts with myelodysplastic syndrome (MDS). We sought to identify, retrospectively, factors associated with better outcome after allografting.
Methods - We conducted a comprehensive chart review of pts with MDS who underwent myeloablative AlloHCT from 1998 to 2010. Background, prognostic variables, and treatment regimens were analyzed to assess their impact on outcome.
Results - 35 pts were transplanted between 1998 and 2010. Median age was 51 (range: 24-66); male to female ratio 1:1; related donor 46% (n=16); matched unrelated donor 54% (n=19). Cytogenetic risk group by IPSS: good, 40% (n=14), intermediate, 37% (n=13), poor, 23% (n=8). Graph type was peripheral blood in 80% (n=28) and bone marrow in 20% (n=7). Median overall survival was 316 days after transplant (range: 248-802). Survival was 77% at day (d) 100; 47% at 1 year (yr); 29% at 3 yr; 11 pts (31%) remain alive. The most common cause of death before d100 was infection and after d100 was GVHD. 8 pts (23%) had ferritin levels <1000 ng/ml before transplant, and in the remaining 27 pts (77%), ferritin levels were >1000 ng/ml. Median survival was five times greater in the group with ferritin levels <1000 ng/ml. At the time of transplantation, 46% (n=16) had progressed to AML; 54% (n=19) had MDS [RA n=5, RAEB-1 n=4, RAEB-2 n=3, RARS n=2, MDS/MPD n=3, CMML n=1, MDS unclassified n=1]. Median survival in MDS was 1157 days versus 109 days in AML (p=0.042). 9 pts (26%) received hypomethylators before transplant; none achieved complete remission (CR). 4 pts (11.4%) attained CR following induction chemotherapy. Although the “CR” group demonstrated a trend towards better survival, results were not statistically significant due to limited sample size.
Conclusions - Our retrospective analysis identified several prognostic factors associated with improved survival following AlloHCT: MDS without evolution to AML, remission at d100, and ferritin level <1000 ng/ml. CR at the time of transplant may be associated with improved survival, but needs further confirmation.
Source:
2011 American Society of Clinical Oncology Annual Meeting; 6562; The Journal of Clinical Oncology; 29 (2011)