Gauthier Jordan, Damaj Gandhi, Langlois Carole, Robin Marie, Michallet Mauricette, Chevallier Patrice, Beguin Yves, N'guyen Stéphanie, Bories Pierre, Blaise Didier, Cornillon Jérôme, Clavert Aline, Mohty Mohamad, Huynh Anne, Thiébaut-Bertrand Anne, Vigouroux Stéphane, Duhamel Alain, Yakoub-Agha Ibrahim
1 CHRU Lille, Pôle Spécialités Médicales et Gérontologie, Service des Maladies du Sang, Secteur Allogreffe de Cellules Souches Hématopoïétiques, F59037, Lille, France. 2 Université de Lille, UFR Médecine F59000, Lille, France. 3 Hematology Department, Caen University Hospital, Amiens, France. 4 Department of Biostatistics, Lille University Hospital, Lille, France. 5 Hematology Department and Hematopoietic Stem Cell Transplantation Unit, Saint-Louis Hospital, Paris, France. 6 Hematology Department, Lyon-Sud Hospital, Lyon, France. 7 Hematology Department, Nantes, France. 8 Hematology Department CH-Liège, Liège, Belgium. 9 Hematology Department, Pitié-Salpêtrière Hospital, Paris, France. 10 Hematology Department, Strasbourg University Hospital, Strasbourg, France. 11 Hematopoietic Stem Cell Transplantation Unit, Paoli Calmettes Institute, Marseille, France. 12 Hematology Department, Loire Oncology Institute (ICL), Saint Priest en Jarez, France. 13 Hematology Department, Nantes University Hospital, Nantes, France. 14 Hematology Department, Saint-Antoine Hospital, Paris, France. 15 Hematology Department, Toulouse University Hospital, Toulouse, France. 16 Hematology Department, Grenoble University Hospital, Grenoble, France. 17 Hematology Department, Bordeaux University Hospital, Bordeaux, France.
Transplantation. 2015 Aug;99(8):1672-80. doi: 10.1097/TP.0000000000000649.
The prognosis of myelodysplastic syndromes (MDS) after allogeneic stem cell transplantation is critically determined by cytogenetic abnormalities, as previously defined by International Prognostic Scoring System (IPSS) cytogenetics. It has been shown that a new cytogenetic classification, included in the IPSS-R (cytogenetic-IPSS-R [C-IPSS-R]), can better predict the outcome of untreated MDS patients.
In this study, we assessed the impact of the IPSS-R cytogenetic score (C-IPSS-R) on the outcome of 367 MDS patients transplanted from HLA-identical siblings or HLA allele-matched unrelated donors.
According to the C-IPSS-R, 178 patients (48%) fell in the good risk, 102 (28%) in the intermediate risk, 77 (21%) in the poor risk, and 10 (3%) in the very poor risk group. In multivariate analysis, after a median follow-up of 4 years, the poor and very poor-risk categories correlated with shorter overall survival (OS) (4-year OS, 32%; hazard ratio [HR], 1.59; P = 0.009 and OS, 10%; HR, 3.18; P = 0.002, respectively) and higher cumulative incidence of relapse (CIR) (CIR, 52%; HR, 1.82; P = 0.004 and CIR, 60%; HR, 2.44; P = 0.060, respectively).
Overall, the C-IPSS-R changed the IPSS cytogenetic risk only in 8% of cases but identified a new risk group, the very poor C-IPSS-R category, with dismal outcome after allogeneic stem cell transplantation (10% 4-year OS, 60% 4-year CIR). Posttransplantation maintenance therapy should be investigated in prospective trials for patients with high-risk C-IPSS-R karyotypes.
异基因干细胞移植后骨髓增生异常综合征（MDS）的预后由细胞遗传学异常严重决定，如国际预后评分系统（IPSS）细胞遗传学先前定义的那样。已表明，纳入IPSS-R（细胞遗传学-IPSS-R [C-IPSS-R]）的新细胞遗传学分类能更好地预测未经治疗的MDS患者的预后。
在本研究中，我们评估了IPSS-R细胞遗传学评分（C-IPSS-R）对367例从 HLA 相同的同胞或 HLA 等位基因匹配的无关供体接受移植的MDS患者预后的影响。
根据C-IPSS-R，178例患者（48%）属于低危组，102例（28%）属于中危组，77例（21%）属于高危组，10例（3%）属于极高危组。在多变量分析中，中位随访4年后，高危和极高危组与较短的总生存期（OS）相关（4年OS，32%；风险比[HR]，1.59；P = 0.009；OS，10%；HR，3.18；P = 0.002）以及较高的累积复发率（CIR）（CIR，52%；HR，1.82；P = 0.004；CIR，60%；HR，2.44；P = 0.060）。
总体而言，C-IPSS-R仅在8%的病例中改变了IPSS细胞遗传学风险，但识别出一个新的风险组，即C-IPSS-R极高危组，异基因干细胞移植后预后不佳（4年OS为10%，4年CIR为60%）。对于C-IPSS-R核型高危的患者，应在前瞻性试验中研究移植后维持治疗。
