Impact of Cytogenetics on Outcome of Patients with MDS or Secondary AML Undergoing Allogeneic HSCT from HLA-Identical Siblings: A Retrospective Analysis of the EBMT-CLWP.
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Le résumé fourni par la source
Abstract Cytogenetics (CG) represent one of the most important factors in determining survival for pts with MDS, being therefore required by the IPSS to predict life-expectancy. However, the impact of CG on outcome of pts undergoing allo-HSCT for MDS is unknown. The aim of this EBMT-CLWP study was to carry out a retrospective analysis of the impact of CG on overall survival (OS), relapse-free survival (RFS), relapse probability (REL), and transplant related mortality (TRM) in pts with MDS/sAML undergoing allo-HSCT from HLA-identical siblings. Data from 1506 pts with MDS/sAML who underwent a first allograft from HLA-identical siblings from 1984 to 2004 reported to EBMT were assessed. The following covariates were included: CG (good- vs standard- vs high-risk according to the IPSS); stage at HSCT (untreated vs treated in CR vs treated not in CR); FAB classification (RA/RARS vs RAEB/CMML vs RAEB-t/sAML); age (as a continuous covariate in the COX models); time from dx to HSCT (<5 vs 5 to 8 vs > 8 months); calendar year in which HSCT was performed; type of conditioning (standard vs RIC); source of stem cells (BM vs PB). A complete information dataset was available in 692 pts, who are the subject of this analysis. 20% of pts had RA or RARS, 28% had RAEB or CMML, and 52% had RAEB-t or sAML. Age was ≥50 years in 30%. CG classified 55% of pts as good-, 24% as intermediate-, and 21% as high-risk. At the time of HSCT, 38% were untreated; among treated pts, 222 (52%) were in CR. A RIC regimen was administered to 93 pts (13%). Source of stem cell was PB in 38%. By univariate analysis, subdivision of pts in the IPSS risk-categories for CG associated with significantly different OS (at 60 mos, alive pts in good-, interm.-, and high-risk groups were 47%, 40% and 31%, respectively), RFS (alive pts at 60 mos 40%, 35% and 21%, respectively), relapse probability (34%, 35% and 57% at 60 mos, respectively) and TRM (33%, 42% and 46% at 60 mos, respectively). By multivariate COX analysis, age and CG associated with all the outcome variables (for OS, high- vs good-risk HR 1.4; interm.- vs good-risk HR 1.2; p<0.02). OS, RFS and REL were also determined by FAB category (for OS, RAEB-t/sAML vs RA/RARS HR 1.5, p<0.01) as well as by stage at HSCT (for OS, CR vs untreated HR 0.65, p<0.005). Conditioning intensity associated both with TRM (reduced vs standard HR 0.5, p<0.01) and REL (reduced vs standard HR 1.63, p<0.02). Concerning REL, the interval between dx and HSCT was also significant, whereas the source of stem cells associated only with OS (PB vs BM HR 0.78, p<0.05). In summary, this study provides evidence that CG have strong prognostic impact on outcome of pts undergoing allo-HSCT from HLA-identical siblings for MDS/sAML and should be taken into consideration when selecting candidates for this treatment strategy. Detailed analyses will be presented.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Impact of Cytogenetics on Outcome of Patients with MDS or Secondary AML Undergoing Allogeneic HSCT from HLA-Identical Siblings: A Retrospective Analysis of the EBMT-CLWP.
- Date Crossref
- 16/11/2006
- Éditeur
- American Society of Hematology
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Milan Hematology pays non établi dans la noticeUniversité ou école supérieure
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico pays non établi dans la noticeÉtablissement de santé
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Leiden University Medical Center pays non établi dans la noticeOrganisme public
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University Medical Center Utrecht pays non établi dans la noticeÉtablissement de santé
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Hematology — University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico et Leiden University Medical Center, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.