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Leukemia. 2017 Nov;31(11):2449-2457. doi: 10.1038/leu.2017.88. Epub 2017 Mar 21.

Decision analysis of allogeneic hematopoietic stem cell transplantation for patients with myelodysplastic syndrome stratified according to the revised International Prognostic Scoring System.

Author information

1
Cancer Center, Humanitas Research Hospital & Humanitas University, Rozzano, Milan, Italy.
2
MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK.
3
Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
4
Division of Hematology and Bone Marrow Transplant, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli, Rome, Italy.
5
Department of Hematology, San Martino Hospital, Genova, Italy.
6
Hematology and Bone Marrow Transplantation Unit, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy.
7
Division of Hematology & Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
8
Hematology & Bone Marrow Transplantation, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
9
Department of Molecular Medicine, University of Pavia, Pavia, Italy.
10
Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome, Italy.
11
Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy.
12
Hematology and Bone Marrow Transplantation Center, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
13
Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
14
Department of Hematology, Rome Transplant Network, Stem Cell Transplant Unit, Policlinico Tor Vergata, Rome, Italy.
15
Department of Hematology Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy.
16
Division of Hematology & Transplant Unit, Ospedale San Gerardo, Monza, Italy.
17
Hematology and Bone Marrow Transplantation Unit, Ospedale Oncologico di Riferimento Regionale A Businco, Cagliari, Italy.
18
Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
19
Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, St Orsola-Malpighi University Hospital, Bologna, Italy.
20
University of Milan, Milan, Italy.

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-SCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non-negligible morbidity and mortality. Crucial questions in clinical decision-making include the definition of optimal timing of the procedure and the benefit of cytoreduction before transplant in high-risk patients. We carried out a decision analysis on 1728 MDS who received supportive care, transplantation or hypomethylating agents (HMAs). Risk assessment was based on the revised International Prognostic Scoring System (IPSS-R). We used a continuous-time multistate Markov model to describe the natural history of disease and evaluate the effect of different treatment policies on survival. Life expectancy increased when transplantation was delayed from the initial stages to intermediate IPSS-R risk (gain-of-life expectancy 5.3, 4.7 and 2.8 years for patients aged ⩽55, 60 and 65 years, respectively), and then decreased for higher risks. Modeling decision analysis on IPSS-R versus original IPSS changed transplantation policy in 29% of patients, resulting in a 2-year gain in life expectancy. In advanced stages, HMAs given before transplant is associated with a 2-year gain-of-life expectancy, especially in older patients. These results provide a preliminary evidence to maximize the effectiveness of allo-SCT in MDS.

PMID:
28321120
PMCID:
PMC6086331
DOI:
10.1038/leu.2017.88
[Indexed for MEDLINE]
Free PMC Article

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