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. 2008 Jul;14(7):799-806.
doi: 10.1016/j.bbmt.2008.04.011.

Pretransplant neutropenia is associated with poor-risk cytogenetic features and increased infection-related mortality in patients with myelodysplastic syndromes

Bart L Scott  1 , J Y Park, H Joachim Deeg, Kieren A Marr, Michael Boeckh, Thomas R Chauncey, Frederick R Appelbaum, Rainer Storb, Barry E Storer
Affiliations

Pretransplant neutropenia is associated with poor-risk cytogenetic features and increased infection-related mortality in patients with myelodysplastic syndromes

Bart L Scott et al. Biol Blood Marrow Transplant. 2008 Jul.

Abstract

A retrospective cohort analysis was performed to determine the impact of neutropenia on the outcome of hematopoietic cell transplantation (HSCT) in patients with myelodysplasia (MDS). Among 291 consecutive patients, 178 (61%) had absolute neutrophil counts (ANCs) <1500/microL and 113 (39%) had ANCs > or =1500/microL within 2 weeks before HSCT. Neutropenic patients more often had poor-risk karyotypes (34% versus 12%, P < .0001) and high-risk International Prognostic Scoring System scores (37% versus 18%, P = .0006). After HSCT, the rate of infections caused by Gram-positive bacteria and invasive fungal infections was significantly increased among neutropenic patients (rate ratio [RR] 1.77, P = .02 and RR = 2.56, P = .03, respectively), whereas infections caused by Gram-negative bacteria were not affected (RR 1.33, P = .53). The hazards of nonrelapse mortality (NRM) (hazard ratio [HR] = 1.62 [1.1-2.4], P = .01), overall mortality (HR = 1.55 [1.1-2.1], P = 0.007), and infection-related mortality (HR = 2.22 [1.2-4.2], P = .01) were increased in neutropenic patients, whereas relapse, engraftment, and graft-versus-host-disease were not affected. After adjusting for cytogenetic risk and marrow myeloblast percentages, neutropenic patients remained at significant hazard for infection-related mortality (HR = 1.94 [1.0-3.8], P = .05), but not for overall mortality or NRM. We propose that intensified strategies to prevent infections should be implemented in MDS patients with preexisting neutropenia who undergo HSCT.

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Figures

Figure 1
Figure 1
Overall survival among neutropenic (ANC <1500/µL) and non-neutropenic (ANC ≥1500/µL) patients. HR=1.55 (1.1–2.1), p=0.007
Figure 2
Figure 2
NRM among neutropenic and non-neutropenic patients. HR=1.62 (1.1–2.4), p=0.01
Figure 3
Figure 3
Infection-related mortality among neutropenic and non-neutropenic patients. HR=2.22 (1.2–4.2), p=0.01
Figure 4
Figure 4
A) Percent of invasive fungal infections among neutropenic and non-neutropenic patients from day 0 to day 100 post-transplant. HR=2.89 (1.2–7.0), p=0.01 B) Percent of gram positive bacterial infections among neutropenic and non-neutropenic patients from day 0 to day 100 post-transplant. HR=1.77 (1.1–2.9), p=0.02
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References

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