Scoring System Predicts MDS Survival in Patients Undergoing HCT

A scoring system including several patient characteristics was found to have significant prognostic value for patients with myelodysplastic syndromes (MDS) undergoing allogeneic hematopoietic cell transplantation (allo HCT), according to a new study.

HCT is the only treatment for MDS that is considered curative. “The decision to proceed with allo HCT, however, is complicated by several factors, including the potential for transplantation-related mortality, disease heterogeneity, and patient comorbidities and preference,” wrote study authors led by Brian C. Shaffer, MD, of Memorial Sloan Kettering Cancer Center in New York.

Other prognostic scoring systems for MDS are not specific to patients undergoing allo HCT, and do not account for factors related to that procedure. The new study included analysis of 2,133 patients who underwent HLA-matched (1,728 patients) or HLA–mismatched (405 patients) allo HCT between 2000 and 2012. The results were published online ahead of print in the Journal of Clinical Oncology.

First, the researchers looked at outcomes from 1,151 HLA-matched patients to create a weighted score; this was then tested in the remaining matched and mismatched patients to validate its prognostic ability.

In the training cohort, several factors were found to be associated with an increased hazard of death. These included blood blasts greater than 3%; platelets 50 x 10⁹/L or less at transplantation; Karnofsky performance status less than 90%; comprehensive cytogenetic risk score of poor or very poor; and age between 30 and 49 years, all of which were assigned one point in the scoring system. Monosomal karyotype and age of 50 years or older were assigned two points.

In the training cohort, with a low score (0–1) used as the reference, an intermediate score (2-3) had a hazard ratio (HR) for death of 1.76 (95% CI, 1.24–2.49; P = .0017). For high scores (4–5) the HR was 2.87 (95% CI, 1.99–4.14; P < .001), and for very high scores (6 or above) the HR was 6.75 (95% CI, 4.28–10.67; P < .001). This was similar in the HLA-matched validation cohort, with HRs for intermediate, high, and very high scores of 1.66 (95% CI, 1.01–2.71; P = .045), 2.29 (95% CI, 1.35–3.87; P = .002), and 5.02 (95% CI, 2.48–10.15; P < .001), respectively.

In 289 HLA-mismatched validation patients, the scoring system was prognostic of relapse (P = .04) but not for overall survival, disease-free survival, or transplantation-related mortality. In HLA-matched patients from both the training and validation cohort, the score was significantly associated with relapse, transplantation-related mortality, and disease-free survival.

“The scoring system uses readily available clinical data and can be calculated quickly, facilitating patient consultation with respect to allo HCT, and may also be used to identify high-risk populations where interventions such as post–allo HCT maintenance therapies may be of benefit,” the authors concluded.