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Blood, 1 August 2008, Vol. 112, No. 3, pp. 895-902.
Prepublished online as a Blood First Edition Paper on May 22, 2008; DOI 10.1182/blood-2008-03-143735.
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Submitted March 5, 2008
Accepted April 30, 2008
WHO classification and WPSS predict post-transplant outcome in patients with myelodysplastic syndrome: a study from the GITMO (gruppo italiano trapianto di midollo osseo)
Emilio Paolo Alessandrino*, Matteo Giovanni Della Porta, Andrea Bacigalupo, Maria Teresa Van Lint, Michele Falda, Francesco Onida, Massimo Bernardi, Anna Paola Lori, Alessandro Rambaldi, Raffaella Cerretti, Paola Marenco, Pietro Pioltelli, Luca Malcovati, Cristiana Pascutto, Rosi Oneto, Renato Fanin, and Alberto Bosi
Department of Hematology, IRCCS Policlinico San Matteo, Pavia, Italy
Division of Hematology, S. Martino's Hospital, Genova, Italy
Division of Hematology, Ospedale San Giovanni Battista, Torino, Italy
Department of Hematology, IRCCS Ospedale Maggiore Policlinico, Milano, Italy
Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Roma, Italy
Division of Hematology, Ospedali Riuniti, Bergamo, Italy
Hemato-Oncology Transplant Unit, University "Tor Vergata", Roma, Italy
Department of Hematology, Ospedale Niguarda Ca' Granda,, Milano, Italy
Division of Hematology and Transplant Unit, Ospedale San Gerardo, University of Milano-Bicocca,, Monza, Italy
Division of Hematology, University of Udine, Udine, Italy
Department of Hematology, University of Florence, Firenze, Italy
* Corresponding author; email: alessandrino{at}smatteo.pv.it.
We evaluated the impact of WHO-classification and WHO classification-based prognostic scoring system (WPSS) on the outcome of patients with myelodysplastic syndrome (MDS) receiving allogeneic stem-cell transplantation (allo-SCT). We studied 365 patients reported to the GITMO between 1990 and 2006. Five-year overall survival (OS) was 80% in refractory anemias, 57% in refractory cytopenias with multilineage dysplasia, 51% in RAEB-1, 28% in RAEB-2 and 25% in acute leukemia from MDS (P=0.001). Five-year probability of relapse was 9%, 22%, 24%, 56% and 53% respectively (P<0.001), while five-year transplant-related mortality (TRM) was 14%, 39%, 38%, 34% and 44%, respectively (P=0.24). In multivariate analysis WHO classification showed a significant effect on OS (P=0.017) and probability of relapse (P=0.01). Transfusion-dependency was associated with a reduced OS (P=0.01) and increased TRM (P=0.037). In multivariate analysis, WPSS showed a prognostic significance on both OS (P=0.001) and probability of relapse (P<0.001). In patients without excess blasts, multilineage dysplasia and transfusion-dependency significantly affected OS (P=0.001 and P=0.009 respectively), and were associated with an increased TRM (P=0.013 and P=0.031 respectively). In these patients, WPSS identified 2 groups with different OS and TRM. These data suggest that WHO classification and WPSS have a relevant prognostic value in post-transplant outcome of MDS patients.
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