Clinical risk factors for patients with myelodysplastic syndromes undergoing allogeneic hematopoietic stem cell transplantation

Figures & data

Figure 1. Kaplan–Meier plots of (a) OS and (b) EFS in 55 patients. The 1-year, 2-year, and 3-year OS rates were 74.5%, 61.8%, and 61.8%, respectively. The 1-year, 2-year, and 3-year EFS rates were 63.6%, 58.2%, and 56.4%, respectively.

Table 1. Characteristics of the 55 patients.

Variables	n (%)
Age at HCT, years
Median	51
Range	30–67
Sex
Male	37 (67.3)
Female	18 (32.7)
Secondary
Yes	6 (10.9)
No	49 (89.1)
WHO 2008 classification at diagnosis
RCUD	6 (10.9)
RARS	0 (0.0)
RCMD	21 (38.2)
RAEB-1	15 (27.3)
RAEB-2	13 (23.6)
MDS-U	0 (0.0)
MDS with isolated del(5q)	0 (0.0)
IPSS-R at diagnosis
Very low	1 (1.8)
Low	7 (12.7)
Intermediate	11 (20.0)
High	11 (20.0)
Very high	11 (20.0)
Missing	14 (25.5)
Cytogenetic status at IPSS-R category at diagnosis
Very good	1 (1.8)
Good	26 (47.3)
Intermediate	13 (23.6)
Poor	7 (12.7)
Very poor	8 (14.5)
WHO 2008 classification before HCT
RCUD	5 (9.1)
RARS	0 (0.0)
RCMD	15 (27.3)
RAEB-1	17 (30.9)
RAEB-2	18 (32.7)
MDS-U	0 (0.0)
MDS with isolated del(5q)	0 (0.0)
ECOG PS before HCT
0 or 1	53 (96.4)
2	2 (36.4)
3 or worse	0 (0.00)
HCT-CI
0	33 (60.0)
1 or 2	13 (23.6)
3 or worse	9 (16.4)
IPSS-R before HCT
Very low	4 (7.3)
Low	4 (7.3)
Intermediate	11 (20.0)
High	15 (27.3)
Very high	16 (29.1)
Missing	5 (9.1)
Cytogenetic status at IPSS-R category before HCT
Very good	1 (1.8)
Good	22 (40.0)
Intermediate	16 (29.1)
Poor	5 (9.1)
Very poor	8 (14.5)
Dry tap	2 (3.6)
Missing	1 (1.8)
Treatment before HCT
None	30 (54.5)
Chemotherapy	8 (14.5)
Hypomethylating agents	13 (23.6)
Immune suppressive therapy	3 (5.5)
Other	1 (1.8)
Time from diagnosis to HCT, months
Median	19
Range	1.4-181.6
Conditioning regimen
Myeloablative	44 (80.0)
Reduced	11 (20.0)
Graft type
Bone marrow	33 (60.0)
Peripheral blood	8 (14.5)
Cord blood	14 (25.5)
HLA type
Matched	28 (50.9)
Mismatched	27 (49.1)
GVHD prophylaxis
Tacrolimus plus methotrexate	34 (61.8)
Cyclosporine plus methotrexate	16 (29.1)
Tacrolimus	3 (5.5)
Cyclosporine	2 (3.6)
ATG
Yes	2 (3.6)
No	53 (96.4)

HCT, hematopoietic cell transplantation; HCT-CI, Hematopoietic Cell Transplant-Comorbidity Index; WHO, World Health Organization; RCUD, refractory cytopenia of unilineage dysplasia; RARS, refractory anemia with ringed sideroblasts; RCMD, refractory cytopenia with multilineage dysplasia; RAEB, refractory anemia with excess blasts; MDS; myelodysplastic syndrome; MDS-U, myelodysplastic syndrome-unclassified; IPSS-R, Revised International Prognostic Scoring System; ECOG PS, Eastern Cooperative Oncology Group performance status; HLA, human leukocyte antigen; GVHD, graft-versus-host disease; ATG, anti-thymocyte globulin

Table 2. Clinical variables for the 55 patients and p-values by univariate analysis for OS and EFS.

Variables	n (%)	P-value for OS	P-value for EFS
Age, years
<55	32 (58.2)
≥55	23 (41.8)	0.005	0.010
HCT-CI
≤2	46 (83.6)
>2	9 (16.4)	0.004	<0.001
IPSS-R before HCT
Intermediate or better	19 (34.5)
High or worse	31 (56.4)	0.159	0.004
Missing	5 (9.1)
Cytogenetic status at IPSS-R category before HCT
Very good or good	23 (41.8)
Intermediate or worse	29 (52.7)	0.019	0.024
Dry tap	3 (5.5)	–	–
Hemoglobin level before HCT, g/L
≥0.8	28 (50.9)
<0.8	27 (49.1)	0.617	0.509
Absolute neutrophil count before HCT, /µL
≥800	27 (49.1)
<800	28 (50.9)	0.022	0.009
Platelet count before HCT, × 10^9/L
≥50	24 (43.6)
<50	31 (56.4)	0.342	0.284
Bone marrow blasts before HCT, %
<5	25 (45.5)
≥5	25 (45.5)	0.638	0.875
Dry tap	3 (5.5)	–	–
Missing	2 (3.6)	–	–
Peripheral blood blasts before HCT, %
<3	41 (74.5)
≥3	14 (25.5)	0.313	0.420
Lactate dehydrogenase before HCT
Normal	35 (63.6)
Elevated	20 (36.4)	0.427	0.481
C-reactive protein before HCT
Normal	25 (45.5)
Elevated	30 (54.5)	0.016	0.011
Ferritin before HCT, ng/mL
≤500	22 (40.0)
>500	28 (50.9)	0.211	0.317
Missing	5 (9.1)	–	–
WT1 mRNA before HCT, copies/mRNA
Normal	1 (1.8)
Elevated	7 (12.7)	0.578	0.384
Missing	47 (85.5)	–	–
β2-microglobulin before HCT, µg/L
Normal	5 (9.1)
Elevated	7 (12.7)	0.394	0.702
Missing	43 (78.2)	–	–
Conditioning regimen
Myeloablative	44 (80.0)
Reduced	11 (20.0)	0.340	0.990
Donor type
Related	21 (38.2)
Unrelated	34 (61.8)	0.084	0.096
HLA type
Matched	28 (50.9)
Mismatched	27 (49.1)	0.376	0.548
GVHD prophylaxis
Tacrolimus	37 (67.3)	0.759	0.455
Cyclophosphamide	18 (32.7)

OS, overall survival; EFS, event-free survival; HCT-CI, Hematopoietic Cell Transplant-Comorbidity Index; HCT, hematopoietic cell transplantation; IPSS-R, Revised International Prognostic Scoring System; WT1, Wilms’ tumor 1; HLA, human leukocyte antigen; GVHD, graft-versus-host disease

Table 3. Multivariate analysis, regression coefficient, and scoring system for 3-year OS and EFS.

	3-year OS			3-year EFS
Variable (regression coefficient for OS/EFS)	Hazard ratio (95% CI)	P-value	Score	Hazard ratio (95% CI)	P-value	Score
Age
<55 years	1 (reference)		0	1 (reference)		0
≥55 years (1.042/0.778)	2.83 (1.06–7.62)	0.038	2	2.22 (0.89–5.5)	0.090	1
HCT-CI
≤2	1 (reference)		0	1 (reference)		0
>2 (1.660/1.882)	5.26 (1.57–17.6)	0.007	3	6.18 (2.07–18.5)	0.001	3
Cytogenetic status before HCT
Very good or good	1 (reference)		0	1 (reference)		0
Intermediate or worse (0.670/0.632)	1.95 (0.64–5.94)	0.238	1	1.88 (0.67–5.24)	0.227	1
Donor type
Related	1 (reference)		0	1 (reference)		0
Unrelated (0.965/0.864)	2.63 (0.85–8.10)	0.067	1	2.37 (0.87–6.50)	0.093	2

OS, overall survival; EFS, event-free survival; HCT, hematopoietic cell transplantation; HCT-CI, Hematopoietic Cell Transplant-Comorbidity Index; CI, confidence interval

Figure 2. ROC curves of the risk model for three-year (a) OS and (b) EFS in all patients. The area under the curve were (a) 0.738 and (b) 0.778 for OS and EFS, respectively. The cutoff values for OS and EFS were (a) 1.635 and (b) 1.420, respectively.

Figure 3. (a) Kaplan–Meier plots of the group (a) lower and (b) higher than the cutoff value point in the risk model for three-year OS. The three-year OS rates were 81.2% for the lower group and 40.0% for the higher group. (b) Kaplan–Meier plots of the group (a) lower and (b) higher than the cutoff value point in the risk model for three-year EFS. The three-year EFS rates were 78.6% for the lower group and 37.5% for the higher group.

Data availability statement

The data supporting the results of this study are available from the corresponding author upon a reasonable request.