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. 2012 Aug 16;120(7):1398-408.
doi: 10.1182/blood-2012-04-423046. Epub 2012 Jul 5.

Five-group cytogenetic risk classification, monosomal karyotype, and outcome after hematopoietic cell transplantation for MDS or acute leukemia evolving from MDS

H Joachim Deeg  1 , Bart L Scott, Min Fang, Howard M Shulman, Boglarka Gyurkocza, David Myerson, John M Pagel, Uwe Platzbecker, Aravind Ramakrishnan, Jerald P Radich, Brenda M Sandmaier, Mohamed Sorror, Derek L Stirewalt, Wendy A Wilson, Rainer Storb, Frederick R Appelbaum, Ted Gooley
Affiliations

Five-group cytogenetic risk classification, monosomal karyotype, and outcome after hematopoietic cell transplantation for MDS or acute leukemia evolving from MDS

H Joachim Deeg et al. Blood. .

Abstract

Clonal cytogenetic abnormalities are a major risk factor for relapse after hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS). We determined the impact of the recently established 5-group cytogenetic classification of MDS on outcome after HCT. Results were compared with the impact of the International Prognostic Scoring System (IPSS) 3 cytogenetic risk groups, and the additional effect of a monosomal karyotype was assessed. The study included data on 1007 patients, 1-75 years old (median 45 years), transplanted from related (n = 547) or unrelated (n = 460) donors. Various conditioning regimens were used, and marrow, peripheral blood, or cord blood served as stem cell source. Both IPSS and 5-group cytogenetic risk classifications were significantly associated with post-HCT relapse and mortality, but the 5-group classification discriminated more clearly among the lowest- and highest-risk patients. A monosomal karyotype tended to further increase the rates of relapse and mortality, even after considering the IPSS or 5-group classifications. In addition, the pathologic disease category correlated with both relapse and mortality. Mortality was also impacted by patient age, donor type, conditioning regimen, platelet count, and etiology of MDS. Although mortality declined significantly in recent years, novel strategies are needed to overcome the barrier of high-risk cytogenetics.

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Figures

Figure 1
Figure 1
Impact of karyotype on posttransplant relapse. (A) Cumulative incidence (CI) of relapse by 5-group cytogenetic classification. (B) CI of relapse by IPSS cytogenetic classification. (C) CI of relapse among patients in the IPSS group “poor,” reclassified by 5-group criteria.
Figure 2
Figure 2
Survival by 5-group cytogenetic classification.
Figure 3
Figure 3
Survival by conditioning regimen.
Figure 4
Figure 4
Impact of monosomal karyotype (MK) on posttransplant relapse and overall survival (OS). Incidence among patients with poor-risk karyotype (by 5-group classification), without or with concurrent MK.
See this image and copyright information in PMC

References

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