TY - JOUR
T1 - Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome
AU - Shaffer, Brian C.
AU - Tallman, Martin
AU - Malone, Adriana K.
AU - Reshef, Ran
AU - Litzow, Mark
AU - Liesveld, Jane
AU - Wiernik, Peter H.
AU - Ahn, Kwang Woo
AU - Hu, Zhen Huan
AU - Saber, Wael
AU - Nishihori, Taiga
AU - Kharfan-Dabaja, Mohamed A.
AU - Valcárcel, David
AU - Grunwald, Michael R.
AU - Fasan, Omotayo
AU - Copelan, Edward
AU - Wood, William Allen
AU - Rizzieri, David A.
AU - Bacher, Ulrike
AU - Hamilton, Betty
AU - Gerds, Aaron
AU - Kalaycio, Matt
AU - Sobecks, Ron
AU - William, Basem
AU - Saad, Ayman
AU - Costa, Luciano J.
AU - Cutler, Corey
AU - Alyea, Edwin
AU - Warlick, Erica
AU - Ustun, Celalettin
AU - Wirk, Baldeep Mona
AU - Sabloff, Mitchell
AU - Daly, Andrew
AU - Marks, David
AU - Gale, Robert Peter
AU - Olsson, Richard
AU - Miller, Alan M.
AU - Kamble, Rammurti
AU - Cortes, Jorge
AU - Popat, Uday
AU - Kindwall-Keller, Tamila L.
AU - Cahn, Jean Yves
AU - Savani, Bipin N.
AU - Vij, Ravi
AU - Maziarz, Richard
AU - Pavletic, Steven
N1 - Publisher Copyright:
© 2016 by American Society of Clinical Oncology.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 3 109 /L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high ([[ampi]]ge; 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.
AB - Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 3 109 /L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high ([[ampi]]ge; 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.
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U2 - 10.1200/JCO.2015.65.0515
DO - 10.1200/JCO.2015.65.0515
M3 - Article
C2 - 27044940
AN - SCOPUS:84974539642
SN - 0732-183X
VL - 34
SP - 1864
EP - 1871
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 16
ER -