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Decision analysis of allogeneic hematopoietic stem cell transplantation for patients with myelodysplastic syndrome stratified according to the revised International Prognostic Scoring System.

Abstract：

:Allogeneic hematopoietic stem cell transplantation (allo-SCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non-negligible morbidity and mortality. Crucial questions in clinical decision-making include the definition of optimal timing of the procedure and the benefit of cytoreduction before transplant in high-risk patients. We carried out a decision analysis on 1728 MDS who received supportive care, transplantation or hypomethylating agents (HMAs). Risk assessment was based on the revised International Prognostic Scoring System (IPSS-R). We used a continuous-time multistate Markov model to describe the natural history of disease and evaluate the effect of different treatment policies on survival. Life expectancy increased when transplantation was delayed from the initial stages to intermediate IPSS-R risk (gain-of-life expectancy 5.3, 4.7 and 2.8 years for patients aged ⩽55, 60 and 65 years, respectively), and then decreased for higher risks. Modeling decision analysis on IPSS-R versus original IPSS changed transplantation policy in 29% of patients, resulting in a 2-year gain in life expectancy. In advanced stages, HMAs given before transplant is associated with a 2-year gain-of-life expectancy, especially in older patients. These results provide a preliminary evidence to maximize the effectiveness of allo-SCT in MDS.

journal_name

Leukemia

journal_title

Leukemia

authors

Della Porta MG,Jackson CH,Alessandrino EP,Rossi M,Bacigalupo A,van Lint MT,Bernardi M,Allione B,Bosi A,Guidi S,Santini V,Malcovati L,Ubezio M,Milanesi C,Todisco E,Voso MT,Musto P,Onida F,Iori AP,Cerretti R,Grillo

doi

10.1038/leu.2017.88

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

2449-2457

issue

11

eissn

0887-6924

issn

1476-5551

pii

leu201788

journal_volume

31

pub_type

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