Department of Hematology Oncology, University of Pavia, Fondazione Policlinico San Matteo, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy.
Haematologica. 2010 Mar;95(3):476-84. doi: 10.3324/haematol.2009.011429. Epub 2009 Nov 10.
Transfusion-dependency affects the natural history of myelodysplastic syndromes. Secondary iron overload may concur to this effect. The relative impact of these factors on the outcome of patients with myelodysplastic syndrome receiving allogeneic stem-cell transplantation remains to be clarified.
We retrospectively evaluated the prognostic effect of transfusion history and iron overload on the post-transplantation outcome of 357 patients with myelodysplastic syndrome reported to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) registry between 1997 and 2007.
Transfusion-dependency was independently associated with reduced overall survival (hazard ratio=1.48, P=0.017) and increased non-relapse mortality (hazard ratio=1.68, P=0.024). The impact of transfusion-dependency was noted only in patients receiving myeloablative conditioning (overall survival: hazard ratio=1.76, P=0.003; non-relapse mortality: hazard ratio=1.70, P=0.02). There was an inverse relationship between transfusion burden and overall survival after transplantation (P=0.022); the outcome was significantly worse in subjects receiving more than 20 red cell units. In multivariate analysis, transfusion-dependency was found to be a risk factor for acute graft-versus-host disease (P=0.04). Among transfusion-dependent patients undergoing myeloablative allogeneic stem cell transplantation, pre-transplantation serum ferritin level had a significant effect on overall survival (P=0.01) and non-relapse mortality (P=0.03). This effect was maintained after adjusting for transfusion burden and duration, suggesting that the negative effect of transfusion history on outcome might be determined at least in part by iron overload.
Pre-transplantation transfusion history and serum ferritin have significant prognostic value in patients with myelodysplastic syndrome undergoing myeloablative allogeneic stem cell transplantation, inducing a significant increase of non-relapse mortality. These results indicate that transfusion history should be considered in transplantation decision-making in patients with myelodysplastic syndrome.
输血依赖会影响骨髓增生异常综合征的自然病程。继发性铁过载可能对此有影响。在接受异基因造血干细胞移植的骨髓增生异常综合征患者中，这些因素对其预后的相对影响仍有待阐明。
我们回顾性评估了输血史和铁过载对 1997 年至 2007 年间向意大利骨髓移植组（GITMO）登记处报告的 357 例骨髓增生异常综合征患者移植后结局的预后影响。
输血依赖与总生存降低独立相关（风险比=1.48，P=0.017），非复发死亡率增加（风险比=1.68，P=0.024）。输血依赖的影响仅见于接受清髓性预处理的患者（总生存：风险比=1.76，P=0.003；非复发死亡率：风险比=1.70，P=0.02）。输血负担与移植后总生存呈负相关（P=0.022）；接受超过 20 个红细胞单位输血的患者预后明显较差。多变量分析显示，输血依赖是急性移植物抗宿主病的危险因素（P=0.04）。在接受清髓性异基因造血干细胞移植的输血依赖患者中，移植前血清铁蛋白水平对总生存（P=0.01）和非复发死亡率（P=0.03）有显著影响。在调整输血负担和持续时间后，这种影响仍然存在，这表明输血史对结局的负面影响至少部分由铁过载决定。
在接受清髓性异基因造血干细胞移植的骨髓增生异常综合征患者中，移植前输血史和血清铁蛋白具有显著的预后价值，可显著增加非复发死亡率。这些结果表明，在骨髓增生异常综合征患者的移植决策中应考虑输血史。
