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Prognostic value of the revised International Prognostic Scoring System five-group cytogenetic abnormality classification for the outcome prediction of hematopoietic stem cell transplantation in pediatric myelodysplastic syndrome

Bone Marrow Transplantation volume 56, pages 3016–3023 (2021)Cite this article

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Abstract

Cytogenetic abnormalities are a major risk factor for relapse after hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS). We aimed to evaluate the value of the five-group cytogenetic classification according to the revised International Prognostic Scoring System (R-IPSS) for predicting the outcome after HSCT in pediatric patients with MDS. We retrospectively analyzed the Japanese registration data of 242 pediatric patients with MDS. According to the R-IPSS classification, 112 (45.5%) patients had good, 55 (22.7%) had intermediate, 64 (26.4%) had poor, and 11 (4.6%) had very poor cytogenetics. The 5-year overall survival (5yOS) was 72%, 69%, 59%, and 30% in the good, intermediate, poor, and very poor cytogenetic subgroups (p = 0.026), respectively. The very good, good, and intermediate subgroups were grouped into a “standard” subgroup and reclassified into three subgroups (standard, poor, and very poor). Patients with very poor risk had worse 5yOS (hazard ratio 2.17, 95% confidence interval (CI) 1.02–4.61; p = 0.04) and a much higher 5yCIR (hazard ratio 2.52, 95% CI 1.05–6.04; p = 0.04) than those of patients in the standard group in the multivariate analysis, indicating that very poor risk cytogenetic characteristics independently predicted worse outcome after HSCT in pediatric patients with MDS.

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Fig. 1: Transplantation outcomes of pediatric MDS patients according to R-IPSS.
Fig. 2: Transplantation outcomes of pediatric MDS patients according to a simplified three-group (standard, poor, and very poor) R-IPSS and an era of HSCT.
Fig. 3: A univariate analysis by a log-rank test.

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Acknowledgements

We thank all medical and co-medical staff who participated in the treatment of pediatric patients with MDS in Japan.

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Authors and Affiliations

  1. Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Kanagawa, Japan

    Shohei Yamamoto

  2. Department of Pediatrics, Showa University Fujigaoka Hospital, Kanagawa, Japan

    Shohei Yamamoto

  3. Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan

    Motohiro Kato

  4. Department of Hematology and Oncology, Shizuoka Children’s Hospital, Shizuoka, Japan

    Kenichiro Watanabe

  5. Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan

    Sae Ishimaru

  6. Department of Pediatrics, St Luke’s International Hospital, Tokyo, Japan

    Daisuke Hasegawa

  7. Department of Pediatrics, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Maiko Noguchi

  8. Department of Hematology and Oncology, Children’s Medical Center, Japanese Red Cross Nagoya First Hospital, Aichi, Japan

    Asahito Hama & Nao Yoshida

  9. Department of Hematology/Oncology, Osaka Women’s and Children’s Hospital, Osaka, Japan

    Maho Sato

  10. Division of Cell Transplantation, Tokai University School of Medicine, Kanagawa, Japan

    Takashi Koike

  11. Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children’s Medical Center, Kanagawa, Japan

    Fuminori Iwasaki

  12. Department of Pediatrics and Child Health, Nihon University Itabashi Hospital, Tokyo, Japan

    Hiroshi Yagasaki

  13. Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan

    Yoshiyuki Takahashi

  14. Department of Hematology and Oncology, Center of Childhood Cancer, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan

    Yoshiyuki Kosaka & Daiichiro Hasegawa

  15. Cancer Immunotherapy/Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshiko Hashii

  16. Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan

    Akira Morimoto

  17. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan

    Yoshiko Atsuta

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Contributions

SY, MK, KW, SI, DH, YA, and NY designed the study, SY performed the statistical analysis, SY, and NY wrote the paper, and MN, AH, MS, TK, FI, HY, YT, YK, YH, and AM were the principal investigators at the centers recruiting the highest number of patients for the study. All authors reviewed and approved the final version of the paper.

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Correspondence to Shohei Yamamoto.

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Yamamoto, S., Kato, M., Watanabe, K. et al. Prognostic value of the revised International Prognostic Scoring System five-group cytogenetic abnormality classification for the outcome prediction of hematopoietic stem cell transplantation in pediatric myelodysplastic syndrome. Bone Marrow Transplant 56, 3016–3023 (2021). https://doi.org/10.1038/s41409-021-01446-z

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