Researchers developed a prognostic model for outcomes with allogeneic hematopoietic stem cell transplantation (allo-HCT) in patients with myelodysplastic syndromes (MDS). They described the model and its application to patients with MDS in a retrospective study with findings recently reported in the journal Hematology.
The researchers evaluated several potential prognostic factors in regression analyses with overall survival (OS) and event-free survival (EFS) as outcomes of interest. Factors that were identified as associated with OS or EFS in univariate analyses based on a P-value of <.1 for each analysis were considered for development of the clinical risk model. Receiver operating characteristic (ROC) analyses were used to assess the model, with 5-fold cross-validation that was repeated 50 times.
A total of 55 patients were included in the study with a median follow-up of 45.8 months (range, 1.27-193), and patients had a median age of 51 years (range, 30-67). The 3-year OS rate in this population was 61.8%, with a 3-year EFS rate of 56.4%. The 3-year NRM rate was 22.2%, and the 3-year incidence of relapse was 22.3%.
Several factors were identified in univariate analysis as appearing associated with OS and/or EFS. However, 6 factors were not included in model development, and the researchers chose 4 factors that they considered most likely useful for inclusion in the clinical risk model. These factors were an age of 55 years or more, a Hematopoietic Cell Transplant-Comorbidity Index of >2 (HCT-CI), a Revised-International Prognostic Scoring System (IPSS-R) cytogenetic status of intermediate or worse, and a status of having an unrelated donor.
In ROC analysis of the 4-factor clinical risk model, the area under the curve (AUC) for the 3-year OS was 0.738, and the AUC for the 3-year EFS was 0.778. After cross-validation, the AUC for the 3-year OS was 0.711, and the AUC for the 3-year EFS was 0.723. The researchers considered this model with 4 clinical risk factors to be predictive of outcomes following allo-HCT in these patients.
Patients were stratified, based on information used in the model, into high- and low-risk groups. The 3-year OS rates was significantly better for the low-risk patients than for the high-risk patients in Kaplan-Meier analysis (hazard ratio [HR], 5.01 (95% CI, 2.07-12.4]; P <.001). A similar pattern was seen with 3-year EFS between low-risk and high-risk groups (HR, 4.72; 95% CI, 1.95-11.4; P <.001).
“We developed a clinical risk model for allo-HCT in MDS, which was based on age ≥55 years, HCT-CI >2, intermediate or worse cytogenetic status before allo-HCT based on IPSS-R classification, and unrelated donor status,” the researchers concluded in their report. They also noted that further efforts should incorporate other disease-related and patient characteristics into models for optimizing personalized treatments.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Teshigawara-Tanabe H, Hagihara M, Aoki J, et al. Clinical risk factors for patients with myelodysplastic syndromes undergoing allogeneic hematopoietic stem cell transplantation. Hematology. 2022;27(1):620-628. doi:10.1080/16078454.2022.2052601