A study published in the European Journal of Haematology indicates that cytogenetic risk and transfusion dependence may serve as prognostic factors in myelodysplastic syndrome (MDS) after allogeneic hematopoietic stem cell transplantation (HSCT), with serum ferritin identified as a surrogate marker for survival.

This retrospective analysis assessed patient characteristics, treatment, and outcomes in all consecutive adult patients with MDS transplanted at the Princess Margaret Cancer Centre in Toronto, Canada, from 2005 to 2018. The study aimed to evaluate survival outcomes (overall survival [OS], relapse-free survival [RFS], cumulative incidence of relapse [CIR], and nonrelapse mortality [NRM]) after allogeneic HSCT and to identify variables affecting survival.

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Data from 125 patients with a median age of 61 years (range, 20-75) were included. Median follow-up duration was 10.9 months (range, 1-156) for all patients and 29 months (range, 2.3-156) for patients who were alive at the last follow up. The 2-year OS, RFS, CIR, and NRM were 39% (95% CI, 30%-48%), 35.3% (95% CI, 27%-44%), 23% (95% CI, 11.3%-35%), and 41.6% (95% CI, 31%-52%), respectively.

In a multivariable analysis, transfusion dependence (hazard ratio [HR], 2.208; 95% CI, 1.386-3.518; P =.0009), very high-risk cytogenetics compared with very low or low-risk cytogenetics (HR, 0.373; 95% CI, 0.206-0.677; P =.0118), and high serum ferritin (HR, 1.729; 95% CI, 1.085-2.754; P =.0212) were independent risk factors for death. Serum ferritin above 1000 ng/mL was significantly associated with 2-year NRM compared with serum ferritin of 1000 ng/mL or lower (50.1% vs 35.3%; P =.0087).

Neither relapse nor survival was associated with the percentage of bone marrow blasts. Induction chemotherapy did not improve survival in patients with refractory anemia with excess blasts-2 compared with cytoreduction with azacitidine alone.

Limitations of this retrospective study include evolving conditioning regimens, graft-versus-host disease prophylaxis, and supportive care protocols over time and a lack of molecular data to assess the influence of specific mutations on outcomes.

The researchers concluded, “Our results highlight the importance of karyotype on survival after allogeneic HSCT and identify serum ferritin and transfusion dependence as important surrogate markers of outcome. In addition, our results demonstrate the efficacy of azacitidine for pretransplant cytoreduction.”

Reference

1.     Prem S, Atenafu EG, Lam W, et al. Allogeneic stem cell transplant in myelodysplastic syndrome‐factors impacting survival [published online November 18, 2019]. Eur J Haematol. doi:10.1111/ejh.13353