Original articleScoring System Based on Post-Transplant Complications in Patients after Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: A Study from the SFGM-TC
Section snippets
INTRODUCTION
Allogeneic hematopoietic cell transplantation (allo-HCT) is a therapeutic option for high-risk hematological disorders including myelodysplastic syndrome (MDS) [1,2]. Nevertheless, this approach is still associated with potentially life-threatening complications such as conditioning-related toxicity, graft-versus-host disease (GVHD), poor graft function and relapse [3,4].
A key issue is managing patients with post-transplant complications. In addition, there is a need for a clinical tool that
PATIENTS AND METHODS
This multicenter study was approved by the board of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), and was conducted in accordance with the Declaration of Helsinki. Written consent to use medically relevant data for research purposes was obtained from each patient and donor before transplant. To ensure confidentiality, each case was anonymized by assignment of a random identification number.
STATISTICAL ANALYSIS
Patients and donor characteristics, transplantation modalities and early complications that occurred within 100 days post-transplant were taken into account. Inclusion of a variable in the predictive model was based on clinical relevance. The following variables were chosen: age at time of transplant; IPSS and cytogenetic score [10,11]; disease status at transplant (responder vs. non responder) according to IWG 2006 criteria [12]; bone marrow blast count at transplant (<5% vs. ≥ 5%), HLA
Database
The derivation cohort included 393 patients and the validation cohort included 391 patients. The median follow-up from transplantation respectively for the derivation and validation cohort was 3.8 years (range, 0.3 to 11.8 years) and 2.9 years (range, 0.4 to 5.5 years). Table 1 reports baseline characteristics and early post-transplant complications of both cohorts. Mean recipient age was 52.0 ± 10.8 years in derivation cohort, and 56.6 ± 9.9 years in validation cohort. In the derivation and
DISCUSSION
To our knowledge, this is the first study to propose a clinical tool generated from variables evaluated after allo-HCT. This tool allows for early post-transplant prognostic assessment in patients with MDS.
Several approaches have been used to attempt to predict patient outcome after allo-HCT. One of these scoring approaches is to apply well-established disease-specific prognostic scores at the time of transplant [1,5,6], which poses significant limitations. By definition, patients eligible for
CONCLUSION
In this study, we created and validated the first prognostic score based on early post-transplant complications to quickly and simply estimate the survival probability of myelodysplastic patients who survived more than 100 days after allo-HCT. Our findings support the robustness, the reliability and the reproducibility of this scoring system. The potential extension of our scoring system, to patients with other hematologic malignancies will be the next phase for the PTSS we propose. This next
Authors Contribution
AC, ED, AD and IYA designed the study, AC, ED, AD, IYA reviewed the data, analyzed results, and made the figures. All authors wrote and approved the manuscript.
Conflict of interest
All authors declare no competing financial interests.
This study was presented in part at the American Society of Hematology (San Diego, 2016).
Research Support
This study was supported in part by a research grant from Association Capucine.
Acknowledgments
The authors would like to thank Mathilde Cuvelier for collecting and checking data on-site. Special thanks to Nicole Raus, the SFGM-TC data manager. The authors wish to acknowledge all our medical teams for their dedication and involvement in daily patient care. A special thanks to Dr. Laura Ravasi for her help writing and proofreading this article. Ibrahim Yakoub-Agha would like to thank Association Capucine for their support in his research.
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