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N. Gagelmann et al.
transplant-specific risk score demonstrated improved prognostic capacity over the IPSS-R, the magnitude of this benefit was still moderate, suggesting that the combined use of prognostic systems may provide the most appropri- ate prognostication, until systems with significantly better performance become available.
None of the existing scores investigated the possible impact of CMV on outcome. CMV is an important cause of morbidity and mortality after allogeneic stem-cell transplantation.18 During recent years, major advances have been achieved regarding antiviral prophylactic strategies, and new sensitive diagnostic techniques have
been developed.19-21 A recent evidence synthesis of the efficacy and safety of different prophylactic strategies for CMV highlighted inconclusive results in terms of sur- vival while CMV disease and infection could be signifi- cantly reduced using antiviral agents.20 Furthermore, it is unclear whether different prophylactic agents for graft- versus-host disease increase the risk for CMV infection or disease after transplantation. Aggregated evidence did not show an increased risk for CMV reactivation in ran- domized trials on antithymocyte globulin, which was given to 46% of our EBMT cohort, in comparison with standard prophylaxis using cyclosporine and methotrex-
Table 3. Transplant-specific MDS risk score prediction of relapse-free survival, non-relapse mortality and incidence of relapse. Relapse-free survival Non-relapse mortality Incidence of relapse
Risk group
Score overall low
intermediate high
very high
HR (95% CI)
reference 2.03 (1.38-2.98) 3.47 (2.39-5.06) 5.77 (3.85-8.66)
P HR (95% CI) P HR (95% CI) P <0.001 <0.001 <0.001
reference <0.001 2.08 (1.16-3.75) <0.001 2.99 (1.68-5.30) <0.001 4.18 (2.25-7.76)
reference 0.01 1.80 (1.04-3.10) <0.001 2.68 (1.57-4.57) <0.001 3.70 (2.09-6.55)
0.03 <0.001 <0.001
HR: hazard ratio; CI: confidence interval.
Figure 2. Nomogram of the EBMT transplant-specific risk score: for each of the seven prognostic factors. Corresponding points are assigned, which are subsequently summed to make a total point scale. This final score is then translated into predicted survival rates at different time points for each patient. CMV: cytomegalovirus; Tx: transplantation; MK: monosomal karyotype; 12m: 12-month; 36m: 36-month; 60m: 60-month.
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haematologica | 2019; 104(5)