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EBMT transplant-specific risk score for MDS
AB
Figure 3. Kaplan-Meier analysis of survival following allogeneic stem-cell transplantation in patients with myelodysplastic syndrome stratified according to their risk group. (A) Center for International Blood and Marrow Transplant Research (CIBMTR) registry. (B) Gruppo Italiano Trapianto di Midollo Osseo (GITMO) registry.
ate or tacrolimus.22 Further analyses, however, showed no significant impact of T-cell depletion or the presence of acute graft-versus-host disease at baseline on outcome of antiviral prophylaxis in terms of CMV infection, sur- vival or safety.20 Hence, the CMV serological status of the transplant recipient still has a strong influence on out- come.23 In our analysis, a positive CMV serostatus of the recipient was associated with a 39% increased risk of death, as well as higher rates of non-relapse mortality. The significant impact of CMV on outcome in a multi- variable model in this large cohort of MDS patients sup- ports further evaluation of antiviral agents, such as leter- movir, affecting not only CMV infection and disease but also mortality.20,21
The role of molecular genetics after transplantation has been investigated recently. Most studies24-26 found a nega- tive impact on outcome in patients with p53 mutations while one study26 suggested that p53 as well as RAS-path- way mutations were mainly seen in patients carrying complex karyotypes. Although molecular genetics have not been included in any existing system and were not available in a suitable number of patients in this analysis, incorporation of genomic aberrations may refine systems in the future.
Regarding conditioning regimens, the introduction of reduced-intensity conditioning has resulted in a significant reduction of transplant-related toxicity and mortality.27 Our analysis, in line with the CIBMTR study, found at least similar effects of reduced-intensity and myeloablative reg- imens. As with any retrospective analysis, these results are prone to bias. Patients perceived as being at greater risk might have been favorably treated using myeloablative conditioning. In our study, patients receiving reduced- intensity conditioning were even older and showed a worse performance status than patients given myeloabla- tive conditioning. This observation is supported by a recent prospective study by the EBMT,28 in which it was found that the administration of reduced-intensity condi- tioning before transplantation in MDS patients resulted in at least an equivalent survival trend for a better overall sur- vival at 2 years, whereas non-relapse mortality appeared to be higher after using myeloablative conditioning.
In conclusion, this EBMT transplant-specific risk score could improve prediction of outcome for MDS patients undergoing allogeneic stem-cell transplantation. This readily available score enables optimized clinical decision- making with respect to allogeneic stem-cell transplanta- tion in patients with MDS.
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2. FenauxP,MuftiGJ,Hellstrom-LindbergE,et al. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase
III study. Lancet Oncol. 2009;10(3): 223-232. Passweg JR, Baldomero H, Bader P, et al. Hematopoietic stem cell transplantation in Europe 2014: more than 40,000 transplants annually. Bone Marrow Transplant. 2016;51(6):786-792.
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