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EBMT transplant-specific risk score for MDS
risk score while C-statistics still showed moderate power; thus, prognostic systems in MDS may be validated and updated offering improved risk stratification if more data become available in the registries in the future.
While another study by the EBMT assessed the prog- nostic utility of the IPSS-R in patients following transplan- tation, finding modest applicability of this disease-specific approach,17 we evaluated two systems that used trans- plant- and patient-related approaches. The CIBMTR score showed limited to modest performance (0.555) but result- ed in an even better prognostic ability (with a concordance index up to 0.582 after cross-validation) in our cohort than originally reported (0.575) while the GITMO score showed better performance (0.579). We acknowledge the limitation of the lack of information regarding the HCT-CI
in a sufficient number of patients, which could therefore not be included in the final multivariable model for the development of the EBMT transplant-specific risk score. The Karnofsky Performance Status was used instead. However, the actual performance status of a patient may vary according to clinicians or at different times during the transplantation evaluation. Other tools evaluating patient fitness, including the HCT-CI may be additionally used as they become available in larger populations.
To investigate to what extent a transplant-specific approach will be generally feasible, we evaluated the prognostic power of the IPSS-R resulting in C-statistics of 0.551 (95% CI: 0.530-0.566), confirming that transplant- specific risk stratification may enable optimized counsel- ing of patients. However, although the proposed EBMT
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Figure 1. Kaplan-Meier analysis of survival following allogeneic stem cell transplantation in patients with myelodysplastic syndrome stratified according to each risk group of the EBMT transplant-specific risk score. (A) Overall survival. (B) Relapse-free survival. (C) Cumulative incidence of relapse. (D) Non-relapse mortality.
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