Utility Of Revised International Prognostic Scoring System (R-IPSS) To Predict Outcome Of Myelodysplastic Syndromes (MDS) Patients After Allogeneic Hematopoietic Stem Cell Transplantation (AHSCT)

The R-IPSS at time of diagnosis was recently proposed and validated as a superior prognostic tool refining the original IPSS. The new model recognized further cytogenetic heterogeneity of the disease, and importance of the depth of cytopenia. The value of R-IPSS at time of AHSCT to predict post-transplant outcomes is not known. We examined the utility of R-IPSS prior to AHSCT in our cohort of MDS patients.

This was a retrospective study. We identified MDS patients who underwent AHSCT in our MDS database. Individual patient charts were reviewed. R-IPSS was calculated at time of transplant using data obtained from tests performed within 30 days of transplant. The R-IPSS karyotype was based on the new proposed 5 groups. The study main objective was to compare overall survival (OS) from time of AHSCT among R-IPSS groups and R-IPSS karyotype groups. Kaplan Meier estimates were used to calculate OS; log rank test was used to compare groups.

Out of 1259 MDS patients in our database, 175 received AHSCT, and we excluded 65 patients who had AHSCT at any point after AML transformation. The median duration of follow up was 46 months (mo) (95% CI 39-53). Table-1 summarizes baseline characteristics of the cohort (n=110). All patients received a reduced intensity AHSCT using fludarabine and IV-busulfan. The rate of acute graft versus host disease (GVHD) II-IV was 68% and 72% for chronic GVHD. The median OS for the whole cohort was 22 mo (95% 10-33 mo.).

The IPSS at time of AHSCT did not predict OS. Based on R-IPSS, 24 pts (22%) were very low, 26 (24%), low, 16 (15%) intermediate, 21 (19%) high, and 23 (21%) were very high. The R-IPSS at time of AHSCT did not predict OS. The median OS was not reached, 14, 52, 20 and 23 mo for very low, low, int, high and very high respectively. (p= 0.1). The R-IPSS karyotype groups did predict OS. The median OS was 29 mo, 26 mo, 19 mo, and 9 mo for good, intermediate, poor and very poor karyotype risk groups respectively (p=0.047)

No other factors prior to AHSCT including age, myeloblasts percentage, Hemoglobin, platelets, treatment before AHSCT had impact on OS in univariate analysis.

IPSS and R-IPSS prior to AHSCT did not predict OS in our cohort of MDS patients. The R-IPSS karyotype group was the only statistically significant prognostic factor prior to AHSCT.

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