Does IPSS-R downstaging before transplantation improve the prognosis of patients with myelodysplastic neoplasms?

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Christof Scheid - , Universitätsklinikum Köln (Autor:in)
  • Diderik-Jan Eikema - , European Society for Blood and Marrow Transplantation Paris (Autor:in)
  • Michel van Gelder - , Akademisches Krankenhaus Maastricht (UMC+) (Autor:in)
  • Urpu Salmenniemi - , Universitätsklinikum Helsinki (Autor:in)
  • Johan Maertens - , Universitair Ziekenhuis (UZ) Leuven (Autor:in)
  • Jakob Passweg - , Universitätsspital Basel (Autor:in)
  • Didier Blaise - , Institut Paoli Calmettes (Autor:in)
  • Jennifer L Byrne - , University of Nottingham (Autor:in)
  • Nicolaus Kröger - , Universitätsklinikum Hamburg-Eppendorf (UKE) (Autor:in)
  • Katja Sockel - , Medizinische Klinik und Poliklinik I (Autor:in)
  • Patrice Chevallier - , CHU de Nantes (Autor:in)
  • Jean Henri Bourhis - , Gustave Roussy Cancer Campus, Villejuif, France. (Autor:in)
  • Jan J Cornelissen - , Erasmus University Medical Center (Autor:in)
  • Henrik Sengeloev - , Righospitalet (Autor:in)
  • Jürgen Finke - , Albert-Ludwigs-Universität Freiburg (Autor:in)
  • John A Snowden - , Sheffield Teaching Hospitals NHS Foundation Trust (Autor:in)
  • Tobias Gedde-Dahl - , Universitätsklinikum Oslo (Autor:in)
  • Jérôme Cornillon - , CHU de Saint-Étienne (Autor:in)
  • Urs Schanz - , Universitätsspital Zürich (Autor:in)
  • Amit Patel - , The Christie NHS Foundation Trust (Autor:in)
  • Linda Koster - , European Society for Blood and Marrow Transplantation Paris (Autor:in)
  • Liesbeth C de Wreede - , Leiden University Medical Centre (LUMC) (Autor:in)
  • Patrick Hayden - , St. James's Hospital (Autor:in)
  • Kavita Raj - , University College London (Autor:in)
  • Joanna Drozd-Sokolowska - , Medical University of Warsaw (Autor:in)
  • Carmelo Gurnari - , University of Rome Tor Vergata (Autor:in)
  • Francesco Onida - , IRCCS Fondazione Ca'Granda – Ospedale Maggiore Policlinico - Milano (Autor:in)
  • Donal P McLornan - , University College London (Autor:in)
  • Marie Robin - , Hôpital Saint-Louis AP-HP (Autor:in)
  • Ibrahim Yakoub-Agha - , Centre Hospitalier Universitaire (CHU) de Lille (Autor:in)

Abstract

In patients with myelodysplastic syndrome (MDS), higher revised International Prognostic Scoring System (IPSS-R) scores at transplant are associated with worse transplant outcome and, thus, lowering IPSS-R scores by therapeutic intervention before transplantation may seem beneficial. However, there is no evidence, to date, to support this approach. In a retrospective analysis, a total of 1482 patients with MDS with sufficient data to calculate IPSS-R score at diagnosis and at time of transplantation were selected from the European Society for Blood and Marrow Transplantation transplant registry and analyzed for transplant outcome in a multivariable Cox model including IPSS-R score at diagnosis, treatment intervention, change in IPSS-R score before transplant, and several patient and transplant variables. Transplant outcome was unaffected by IPSS-R score change in untreated patients and moderately superior in patients treated with chemotherapy with improved IPSS-R score at transplant. Improved IPSS-R score after hypomethylating agents (HMAs) or other therapies showed no beneficial effect. However, when IPSS-R score progressed after chemotherapy, HMAs, or other therapies, transplant outcome was worse than without any prior treatment. Similar results were found when reduction or increase in bone marrow (BM) blasts between diagnosis and transplantation was considered. The results show a limited benefit of IPSS-R score downstaging or reduction of BM blasts after chemotherapy and no benefit for HMAs or other treatments and thus question the role of prior therapy in patients with MDS scheduled for transplantation. The model-based survival estimates should help inform decision-making for both doctors and patients.

Details

OriginalspracheEnglisch
Seiten (von - bis)445-456
Seitenumfang12
FachzeitschriftBlood
Jahrgang144
Ausgabenummer4
PublikationsstatusVeröffentlicht - 25 Juli 2024
Peer-Review-StatusJa

Externe IDs

Scopus 85196369656

Schlagworte

Schlagwörter

  • Humans, Myelodysplastic Syndromes/therapy, Male, Female, Middle Aged, Aged, Retrospective Studies, Prognosis, Adult, Hematopoietic Stem Cell Transplantation/methods, Neoplasm Staging, Treatment Outcome, Young Adult