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Blood, Vol. 92 No. 6 (September 15), 1998:
pp. 1910-1917
Cytogenetic Abnormalities in Primary Myelodysplastic Syndrome Are
Highly Predictive of Outcome After Allogeneic Bone Marrow
Transplantation
Thomas J. Nevill,
Henry C. Fung,
John D. Shepherd,
Douglas E. Horsman,
Stephen H. Nantel,
Hans-G. Klingemann,
Donna L. Forrest,
Cynthia L. Toze,
Heather J. Sutherland,
Donna E. Hogge,
Sheldon C. Naiman,
Alan Le,
Daphne A. Brockington, and
Michael J. Barnett
From The Leukemia and Bone Marrow Transplantation Program of British
Columbia, the Divisions of Hematology and Laboratory Medicine, British
Columbia Cancer Agency, Vancouver Hospital and Health Sciences Centre,
and the University of British Columbia, Vancouver, British Columbia,
Canada.
Allogeneic bone marrow transplantation (BMT) is the only curative
therapy available for patients with myelodysplastic syndrome (MDS). In
an attempt to identify prognostic factors influencing outcome, we
collected data retrospectively on 60 consecutive adult patients who had
undergone BMT at our center for primary MDS or acute myelogenous
leukemia evolving from preexisting primary MDS (sAML). Patients were
divided into subgroups according to cytogenetic abnormalities based on
a recently described International MDS Workshop categorization system.
The 7-year actuarial event-free survival (EFS), relapse rate, and
nonrelapse mortality (NRM) for all patients were 29% (95% confidence
interval [CI], 16% to 43%), 42% (CI, 24% to 67%), and 50% (CI,
37% to 64%), respectively. The EFS for the good-, intermediate-, and
poor-risk cytogenetic subgroups were 51% (CI, 30% to 69%), 40% (CI,
16% to 63%), and 6% (CI, 0% to 24%), respectively (P
= .003). The corresponding actuarial relapse rates were 19% (CI,
6% to 49%), 12% (CI, 2% to 61%), and 82% (CI, 48% to 99%),
respectively (P = .002) with no difference in NRM between the
subgroups. Univariate analysis showed cytogenetic category,
French-American-British (FAB) subtype, and graft-versus-host disease
(GVHD) prophylaxis used to be predictive of relapse and
EFS. In multivariate analysis, only the cytogenetic category was
predictive of EFS, with the relative risk of treatment failure for the
good-, intermediate-, and poor-risk cytogenetic subgroups being 1.0, 1.5, and 3.5, respectively (P = .004). For adults with
primary MDS and sAML, even after BMT, poor-risk cytogenetics are
predictive of an unfavorable outcome; novel treatment strategies will
be required to improve results with allogeneic BMT in this patient
population.
© 1998 by The American Society of Hematology.
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