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Acute Leukemia

Dynamic prognostic value of the revised international prognostic scoring system following pretransplant hypomethylating treatment in myelodysplastic syndrome

Bone Marrow Transplantation volume 52, pages 522–531 (2017)Cite this article

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Abstract

This study aimed to analyze the use of the revised International Prognostic Scoring System (IPSS-R) assessed after hypomethylating treatment (HMT) for patients with myelodysplastic syndrome (MDS) undergoing an allogeneic stem cell transplantation (SCT). Among 115 patients who received pre-SCT HMT, comparison analysis of the prognostic values between the IPSS-R at the time of HMT (IPSS-R@HMT) and at the time of SCT after HMT (IPSS-R@SCT) showed a significantly higher predictive power for overall survival (OS) of the latter. Alteration in IPSS-R risk occurred in 60%, while the patients with ‘down-staged’ IPSS-R@SCT showed better OS compared with those with ‘unchanged’ or ‘up-staged’ risk. On multivariate analysis in all 201 patients, IPSS-R@SCT, monosomal karyotype, treatment failure to pre-SCT treatment, and high hematopoietic cell transplantation-comorbidity index were independently associated with OS. Constructed using these factors, the MDS Transplantation Prognostic Scoring System (MTPSS) identified four risk groups with 4-year OS of 76.4% in low, 61.4% in intermediate-1 and 21.9% in intermediate-2 risk groups, whereas all in the high risk group died within 2 years after SCT (P<0.001). Our study emphasizes the need for further studies aiming to evaluate a transplantation prognostic model such as the MTPSS to make appropriate decisions for transplantation in MDS.

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Acknowledgements

This study was supported by a grant from the Ministry for Health and Welfare (A120175). The authors acknowledge all members at Catholic Blood and Marrow Transplantation Center and Asan Medical Center, particularly the house staff, for their excellent patient care.

Author contributions

YJK and JHL were the principal investigators and take primary responsibility for the paper; SAY, YJK and JHL collected the data and performed the statistical analysis, interpreted the results and wrote the manuscript; YWJ, JHY, SHS, SEL, YSC and DYK participated in the clinical data management; JHL, BSC, KSE, SL, CKM and HJK participated in the statistical analysis; JWL, KHL and WSM commented on the manuscript.

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  1. J-H Lee and Y-J Kim: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    S-A Yahng

  2. Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Y-W Jeon, J-H Yoon, S-E Lee, B-S Cho, K-S Eom, S Lee, C-K Min, H-J Kim, J-W Lee, W-S Min & Y-J Kim

  3. Department of Hematology, Yeoido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    S-H Shin

  4. Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Y-S Choi, D-Y Kim, J-H Lee, K-H Lee & J-H Lee

  5. Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea

    B-S Cho, K-S Eom, S Lee, C-K Min, H-J Kim & Y-J Kim

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Yahng, SA., Jeon, YW., Yoon, JH. et al. Dynamic prognostic value of the revised international prognostic scoring system following pretransplant hypomethylating treatment in myelodysplastic syndrome. Bone Marrow Transplant 52, 522–531 (2017). https://doi.org/10.1038/bmt.2016.295

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