Abstract
The factors that influence utilization of reduced-intensity conditioning hematopoietic stem cell transplantation (RIC HSCT) for “fit” elderly patients with advanced myelodysplastic syndromes (MDS) remain unclear.
The “MDS Transplant-Associated Outcomes Study,” or “MDS-TAO,” is a prospective longitudinal observational study which began at the Dana-Farber/Harvard Cancer Center in May of 2011. It is designed to examine survival, quality of life (QoL), and other outcomes for RIC HSCT versus non-HSCT approaches for HSCT-appropriate MDS patients ages 60 to 75. Inclusion criteria include: histologically-confirmed diagnosis of MDS or CMML, and at least one of the following: (1) therapy-related disease, or (2) intermediate-2/high risk IPSS (Greenberg, 1997), or (3) intermediate/poor-prognosis risk cytogenetics (Haase, 2007), or (4) severe and sustained anemia or thrombocytopenia, or (5) platelet or red cell transfusion dependence. Exclusions include: (1) comorbidities that in the judgment of the enrolling clinician preclude HSCT eligibility (2) prior donor search, and (3) patient unwillingness to consider HSCT. For this analysis, time to HSCT was estimated using Kaplan-Meier methods, and log rank tests were used to assess time to HSCT by age, gender, ECOG performance status, IPSS, IPSS cytogenetic risk group, and baseline EORTC QLQ-C30 global QoL and fatigue scores.
As of April 30, 2013, 87 patients had been enrolled. The median age was 69 years, 66% were male, and 88% had an ECOG performance status of 0 or 1. As of July 15, 2013, 22 had received HSCT within a median of 4.0 months (range 2-10 months) from study enrollment, and 17 had died without receiving HSCT. The 9-month probability of having had a transplant was 31% (95% CI [21% to 44%]). The median global QoL score was 66.7 and the median fatigue score was 33.3 (published medians are 66.7 and 33.3 for other cancers; higher global QoL scores indicate superior QoL whereas higher fatigue scores indicate worse fatigue). MDS-TAO patients with poorer cytogenetics (p<.001) and worse IPSS at enrollment (p<.001) were more likely to undergo HSCT. Age showed a complex relationship (p=.03), with those aged 65-70 most likely to undergo HSCT (34%), followed by those aged 60-65 (33%), and those aged >70 (11%). Female gender (p=.10), performance status (p=.14), global QoL (p=.56; see figure), and fatigue score (p=.58; see figure) all showed no significant association with the likelihood of undergoing HSCT.
Our data suggest that while older transplant-appropriate MDS patients suffer from similar QoL impairment as compared to other cancer patients, cytogenetics and IPSS likely have more influence than patient-reported QoL in influencing which patients ultimately receive HSCT.
No relevant conflicts of interest to declare.
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