Prognostic factors in myelodysplastic syndromes following myeloablative allogenic bone marrow transplantation-a twelve year follow up study

Abstract

Significance of various prognostic factors in myelodysplastic syndromes was retrospectively explored in 82 patients who underwent myeloablative allogenic stem cell transplantation between years 1988–1999 at Karmanos Cancer Institute, Detroit, Michigan. Follow up ranged from 1 month to 12 years (median 4 years). Median age was 45 years (range: 4–66 years). Preparative regimen was busulfan, cytarabine and cyclophosphamide. Seventy-two patients were transplanted with unmanipulated bone marrow and 10 patients received peripheral blood stem cells either from HLA identical related (n = 44) or unrelated (n = 26) or partially mismatched donor (n = 12). Relapse rate was low 16% (13/82) and overall survival was 52% at a median follow up of 4 years. Risk category based on the International Prognostic Scoring System (IPSS) at the time of transplant and median survival respectively was: low (n = 14, median not reached), intermediate-1 (n = 39, 110 months), intermediate-2 (n = 19, 27 months) and high (n = 10, median not reached). Predictors evaluated were age, time from diagnosis to transplant, bone marrow blasts, cytogenetics, risk scoring (IPSS), FAB classification at the time of transplantation and bone marrow cellularity. Age was not significantly associated with other predictors. In univariate analysis, bone marrow blasts, FAB classification and cytogenetics were weakly associated with overall survival. Risk scoring (IPSS) had same predictive value for survival as bone marrow blasts and cytogenetics in univariate analysis. In multivariable model, all the predictors had little predictive ability for survival. Given the low relapse rates in our study, it is not surprising that there was even less predictive ability in multivariate model for relapse. In conclusion, a substantial number of patients in all the risk categories achieved long-term disease free survival. Risk stratification at the time of allogenic transplantation may not predict the long-term survival and this curative treatment should be offered to patients in all the risk categories.