학술논문
Does IPSS-R down staging before transplantation improve the prognosis of patients with Myelodysplastic neoplasms?
Document Type
Academic Journal
Author
Scheid C; University Hospital Cologne, Cologne, Germany.; Eikema DJ; EBMT Leiden Study Unit, Leiden, Netherlands.; Van Gelder M; Maastricht University Medical Center, Maastricht, Netherlands.; Salmenniemi U; Helsinki University Hospital, Helsinki, Finland.; Maertens J MD; University Hospital Gasthuisberg, Leuven, Belgium.; Passweg JR; University Hospital Basel, Basel, Switzerland.; Blaise D; Institut Paoli Calmettes, Marseille, France.; Byrne JL; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.; Kroeger N; University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Sockel K; University Hospital Carl Gustav Carus, TU Dresden, German Cancer Consortium (DKTK) , Dresden, Germany, Dresden, Germany.; Chevallier P; Centre Hospitalo-Universitaire, Nantes, France.; Bourhis JH; Institut Gustave Roussy, Villejuif, France.; Cornelissen JJ; Erasmus MC, Cancer Institute, Rotterdam, Netherlands.; Sengeloev H; Rigshospitalet, Copenhagen, Denmark.; Finke J; University Medical Center and Medical Faculty, Freiburg, Freiburg, Germany.; Snowden JA; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.; Gedde-Dahl T; Department of Medicine, Oslo University Hospital, Oslo.; Cornillon J; University Hospital of Saint-Etienne, Saint-Etienne, France.; Schanz U; University Hospital of Zurich, Zurich, Switzerland.; Patel A; in memoriam, United Kingdom.; Koster L; EBMT Data Office, Leiden, Netherlands.; de Wreede LC; Leiden University Medical Center, Leiden, Netherlands.; Hayden PJ; School of Medicine, Trinity College Dublin, Dublin, Ireland.; Raj K; University College London Hospitals NHS Foundation Trust, London, United Kingdom.; Drozd-Sokolowska J; Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland.; Gurnari C; University of Rome Tor Vergata, Italy.; Onida F; Hematology and BMT Unit, ASST Fatebenefratelli-Sacco, Dept. of Oncology and Hemato-Oncology, University of Milan, Italy, Milan, Italy.; McLornan DP; University College Hospital, London, United Kingdom.; Robin M; Hopital Saint Louis, Paris, France.; Yakoub-Agha I; Cellular therapy unit, Lille, France.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 7603509 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-0020 (Electronic) Linking ISSN: 00064971 NLM ISO Abbreviation: Blood Subsets: MEDLINE
Subject
Language
English
Abstract
In MDS patients higher IPSS-R at transplant is associated with worse transplant outcome. Thus, it may seem beneficial to improve IPSS-R by therapeutic intervention prior to transplantation in order to "down-stage" the disease risk. However, there is no evidence to date to support this approach. A retrospective analysis of the EBMT transplant registry was performed to investigate the role of therapeutic interventions prior to transplantation with regard to changes in IPSS-R and transplant outcomes. A total of 1482 MDS patients with sufficient data to calculate IPSS-R at diagnosis and at time of transplantation were selected and analysed for transplant outcome in a multivariable Cox model including IPSS-R at diagnosis, treatment intervention, change in IPSS-R before transplant and several patient and transplant variables. Transplant outcome was unaffected by IPSS-R change in untreated patients and moderately superior in chemotherapy-treated patients with improved IPSS-R at transplant. Improved IPSS-R after hypomethylating agents (HMA) or other therapies showed no beneficial effect. However, when IPSS-R progressed after chemotherapy, (HMA) 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 down staging or reduction of BM blasts after chemotherapy and no benefit for HMA or other treatments and thus question the role of prior therapy in MDS patients scheduled for transplantation. The model-based survival estimates should help inform decision making for both doctors and patients.
(Copyright © 2024 American Society of Hematology.)
(Copyright © 2024 American Society of Hematology.)