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Ann Hematol. 2016 Dec;95(12):1971-1978. Epub 2016 Sep 20.

Prognostic pre-transplant factors in myelodysplastic syndromes primarily treated by high dose allogeneic hematopoietic stem cell transplantation: a retrospective study of the MDS subcommittee of the CMWP of the EBMT.

Author information

1
VU University Medical Center, Amsterdam, The Netherlands. e.cremers@vumc.nl.
2
Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. e.cremers@vumc.nl.
3
Leiden University Medical Center, Leiden, The Netherlands.
4
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
5
University of Freiburg, Freiburg, Germany.
6
Universitatsklinikum Dresden, Dresden, Germany.
7
University Hospital, Essen, Germany.
8
Deutsche Klinik fur Diagnostik and KMT, Wiesbaden, Germany.
9
Helsinki University Central Hospital, Helsinki, Finland.
10
Evangelismos Hospital, Athens, Greece.
11
Radboud University Medical Centre, Nijmegen, The Netherlands.
12
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
13
University Hospital Eppendorf, Hamburg, Germany.

Abstract

Many pre-transplant factors are known to influence the outcome of allogeneic stem cell transplantation (SCT) treatment in myelodysplastic syndromes (MDS). However, patient cohorts are often heterogeneous by disease stage and treatment modalities, which complicates interpretation of the results. This study aimed to obtain a homogeneous patient cohort by including only de novo MDS patients who received upfront allogeneic SCT after standard high dose myelo-ablative conditioning. The effect of pre-transplant factors such as age, disease stage, transfusions, iron parameters and comorbidity on overall survival (OS), non-relapse mortality (NRM), and relapse incidence (RI) was evaluated in 201 patients. In this cohort, characterized by low comorbidity and a short interval between diagnosis and transplantation, NRM was the most determinant factor for survival after SCT (47 % after 2-year follow-up). WHO classification and transfusion burden were the only modalities with a significant impact on overall survival after SCT. Estimated hazard ratios (HR) showed a strongly increased risk of death, NRM and RI, in patients with a high transfusion-burden (HR 1.99; P = 0.006, HR of 1.89; P = 0.03 and HR 2.67; P = 0.03). The HR's for ferritin level and comorbidity were not significantly increased.

KEYWORDS:

Allogeneic hematopoietic stem cell transplantation; Allogeneic stem cell transplantation; Comorbidity; Iron overload; Myelodysplastic syndromes; Prognosis; Red blood cell transfusion

PMID:
27650829
PMCID:
PMC5093200
DOI:
10.1007/s00277-016-2802-z
[Indexed for MEDLINE]
Free PMC Article

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