Impact of cytogenetic aberrations divided into 5 prognostic groups upon outcomes of allo-HSCT patients with myelodysplastic syndromes
Maria V. Gubina, Tatyana L. Gindina, Nikolay N. Mamaev, Elena S. Nikolaeva, Irina A. Petrova, Anna A. Osipova, Elena V. Morozova, Yulia V. Rudnitskaya, Ludmila S. Zubarovskaya, Boris V. Afanasyev
R. M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Chair of Hematology, Transfusiology and Transplantology, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation
Summary
Introduction
The aim of our study was to evaluate the impact of cytogenetic aberrations upon outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a mixed cohort of patients (pts) with myelodysplastic syndrome (MDS), classified into 5 cytogenetically defined groups.Patients and methods
Sixty patients with various cytogenetic variants of MDS were included in this study. They had undergone allo-HSCT at our University within a time period of 2009 to 2016. The age of patients ranged from 9 months to 61 years (median, 28.6 y.o.). There were 22 children (38%) and 38 adults (62%) with primary and secondary MDS (51 and 9 pts, respectively). Post-transplant transformation into AML occurred in 5 pts (8%). Allo-HSCT from HLA-matched unrelated and matched related donor was performed in 42 (70%) and 13 (22%) cases, respectively. In 5 patients (8%), HSCT was performed from a haploidentical related donor. Stem cell sources for HSCT were bone marrow and peripheral blood in 39 (65%) and 21 (35%) pts, respectively.Results
Quantitative chromosomal abnormalities were detected in 16 (27%) pts, structural abnormalities, in 17 (28%) pts. Combined quantitative/structural chromosomal abnormalities occured in 11 (18%) pts, normal karyotype was revealed in 16 (27%) cases. All patients were divided into 5 prognostic groups in accordance with the cytogenetic abnormalities found, and conventional IPSS-R classification. Most favorable and good prognosis groups included 2 (3%) and 23 (38%) pts, respectively. The group with intermediate prognosis consisted of 10 (17%) pts, whereas a group of poor or very poor prognosis was presented by 22 (37%) and 3 (5%) pts, respectively. A complex karyotype (CK), defined as three or more chromosome abnormalities seen in metaphase cells, was present in 3 (5%) pts. One abnormal cytogenetic clone was identified in 36 (82%) pts, whereas two or more abnormal clones were in 8 (18%) pts. Univariate analysis showed the two-year overall survival (OS) in very good group, in common good and intermediate group, poor and very poor cytogenetic groups it was 100%, 71%, 44%, and 0%, respectively (p=0.009). Patients without complex chromosome abnormalities in the karyotype had OS and LFS significantly higher than those with CK (61% vs. 0% for OS p=0.003, and 51% vs. 0% for LFS, p=0.05). A trend OS and LFS increase was observed for pts with one abnormal cytogenetic clone in karyotype compared with patients showing 2 or more abnormal clones (56% vs. 25%, p=0.12 for OS; 46% vs. 12%, p=0.08 for LFS). Moreover, LFS were similar for the patients who received a transplant from HLA-matched related and unrelated donors (54% and 50%). At the same time, it was significantly lower in haploidentical HSCT (20%, p=0.04). Finally, it should be mentioned, that there was no difference in results of the allo-HSCT in pts with different clinical variants of MDS, age and gender of either pts or donors, graft sources, as well as time from diagnosis to HSCT.Conclusion
On the basis of 2-years OS and LFS findings a conclusion is drawn that the 5-group prognostic cytogenetic classification of MDS is useful for clinical purposes and should be included into the further studies on the topic.Keywords
Myelodysplastic syndrome, allo-HSCT, chromosomal abnormalities, IPSS-R scores.