Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome

Brian C. Shaffer, Martin Tallman, Adriana K. Malone, Ran Reshef, Mark R Litzow, Jane Liesveld, Peter H. Wiernik, Kwang Woo Ahn, Zhen Huan Hu, Wael Saber, Taiga Nishihori, Mohamed A. Kharfan-Dabaja, David Valcárcel, Michael R. Grunwald, Omotayo Fasan, Edward Copelan, William Allen Wood, David A. Rizzieri, Ulrike Bacher, Betty HamiltonAaron Gerds, Matt Kalaycio, Ron Sobecks, Basem William, Ayman Saad, Luciano J. Costa, Corey Cutler, Edwin Alyea, Erica Warlick, Celalettin Ustun, Baldeep Mona Wirk, Mitchell Sabloff, Andrew Daly, David Marks, Robert Peter Gale, Richard Olsson, Alan M. Miller, Rammurti Kamble, Jorge Cortes, Uday Popat, Tamila L. Kindwall-Keller, Jean Yves Cahn, Bipin N. Savani, Ravi Vij, Richard Maziarz, Steven Pavletic

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 3 109 /L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high ([[ampi]]ge; 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.

Original languageEnglish (US)
Pages (from-to)1864-1871
Number of pages8
JournalJournal of Clinical Oncology
Volume34
Issue number16
DOIs
StatePublished - Jun 1 2016

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Myelodysplastic Syndromes
Cell Transplantation
Transplantation
Karnofsky Performance Status
Recurrence
Mortality
Karyotype
Proportional Hazards Models
Cytogenetics
Blood Platelets
Survival

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

Cite this

Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome. / Shaffer, Brian C.; Tallman, Martin; Malone, Adriana K.; Reshef, Ran; Litzow, Mark R; Liesveld, Jane; Wiernik, Peter H.; Ahn, Kwang Woo; Hu, Zhen Huan; Saber, Wael; Nishihori, Taiga; Kharfan-Dabaja, Mohamed A.; Valcárcel, David; Grunwald, Michael R.; Fasan, Omotayo; Copelan, Edward; Wood, William Allen; Rizzieri, David A.; Bacher, Ulrike; Hamilton, Betty; Gerds, Aaron; Kalaycio, Matt; Sobecks, Ron; William, Basem; Saad, Ayman; Costa, Luciano J.; Cutler, Corey; Alyea, Edwin; Warlick, Erica; Ustun, Celalettin; Wirk, Baldeep Mona; Sabloff, Mitchell; Daly, Andrew; Marks, David; Gale, Robert Peter; Olsson, Richard; Miller, Alan M.; Kamble, Rammurti; Cortes, Jorge; Popat, Uday; Kindwall-Keller, Tamila L.; Cahn, Jean Yves; Savani, Bipin N.; Vij, Ravi; Maziarz, Richard; Pavletic, Steven.

In: Journal of Clinical Oncology, Vol. 34, No. 16, 01.06.2016, p. 1864-1871.

Research output: Contribution to journalArticle

Shaffer, BC, Tallman, M, Malone, AK, Reshef, R, Litzow, MR, Liesveld, J, Wiernik, PH, Ahn, KW, Hu, ZH, Saber, W, Nishihori, T, Kharfan-Dabaja, MA, Valcárcel, D, Grunwald, MR, Fasan, O, Copelan, E, Wood, WA, Rizzieri, DA, Bacher, U, Hamilton, B, Gerds, A, Kalaycio, M, Sobecks, R, William, B, Saad, A, Costa, LJ, Cutler, C, Alyea, E, Warlick, E, Ustun, C, Wirk, BM, Sabloff, M, Daly, A, Marks, D, Gale, RP, Olsson, R, Miller, AM, Kamble, R, Cortes, J, Popat, U, Kindwall-Keller, TL, Cahn, JY, Savani, BN, Vij, R, Maziarz, R & Pavletic, S 2016, 'Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome', Journal of Clinical Oncology, vol. 34, no. 16, pp. 1864-1871. https://doi.org/10.1200/JCO.2015.65.0515
Shaffer, Brian C. ; Tallman, Martin ; Malone, Adriana K. ; Reshef, Ran ; Litzow, Mark R ; Liesveld, Jane ; Wiernik, Peter H. ; Ahn, Kwang Woo ; Hu, Zhen Huan ; Saber, Wael ; Nishihori, Taiga ; Kharfan-Dabaja, Mohamed A. ; Valcárcel, David ; Grunwald, Michael R. ; Fasan, Omotayo ; Copelan, Edward ; Wood, William Allen ; Rizzieri, David A. ; Bacher, Ulrike ; Hamilton, Betty ; Gerds, Aaron ; Kalaycio, Matt ; Sobecks, Ron ; William, Basem ; Saad, Ayman ; Costa, Luciano J. ; Cutler, Corey ; Alyea, Edwin ; Warlick, Erica ; Ustun, Celalettin ; Wirk, Baldeep Mona ; Sabloff, Mitchell ; Daly, Andrew ; Marks, David ; Gale, Robert Peter ; Olsson, Richard ; Miller, Alan M. ; Kamble, Rammurti ; Cortes, Jorge ; Popat, Uday ; Kindwall-Keller, Tamila L. ; Cahn, Jean Yves ; Savani, Bipin N. ; Vij, Ravi ; Maziarz, Richard ; Pavletic, Steven. / Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 16. pp. 1864-1871.
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title = "Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome",
abstract = "Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3{\%} (hazard ratio [HR], 1.41; 95{\%} CI, 1.08 to 1.85), platelets 50 3 109 /L or less at transplantation (HR, 1.37; 95{\%} CI, 1.18 to 1.61), Karnofsky performance status less than 90{\%} (HR, 1.25; 95{\%} CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95{\%} CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95{\%} CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95{\%} CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95{\%} CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high ([[ampi]]ge; 6) scores was 71{\%} (95{\%} CI, 58{\%} to 85{\%}), 49{\%} (95{\%} CI, 42{\%} to 56{\%}), 41{\%} (95{\%} CI, 31{\%} to 51{\%}), and 25{\%} (95{\%} CI, 4{\%} to 46{\%}), respectively (P [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.",
author = "Shaffer, {Brian C.} and Martin Tallman and Malone, {Adriana K.} and Ran Reshef and Litzow, {Mark R} and Jane Liesveld and Wiernik, {Peter H.} and Ahn, {Kwang Woo} and Hu, {Zhen Huan} and Wael Saber and Taiga Nishihori and Kharfan-Dabaja, {Mohamed A.} and David Valc{\'a}rcel and Grunwald, {Michael R.} and Omotayo Fasan and Edward Copelan and Wood, {William Allen} and Rizzieri, {David A.} and Ulrike Bacher and Betty Hamilton and Aaron Gerds and Matt Kalaycio and Ron Sobecks and Basem William and Ayman Saad and Costa, {Luciano J.} and Corey Cutler and Edwin Alyea and Erica Warlick and Celalettin Ustun and Wirk, {Baldeep Mona} and Mitchell Sabloff and Andrew Daly and David Marks and Gale, {Robert Peter} and Richard Olsson and Miller, {Alan M.} and Rammurti Kamble and Jorge Cortes and Uday Popat and Kindwall-Keller, {Tamila L.} and Cahn, {Jean Yves} and Savani, {Bipin N.} and Ravi Vij and Richard Maziarz and Steven Pavletic",
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TY - JOUR

T1 - Scoring system prognostic of outcome in patients undergoing allogeneic hematopoietic cell transplantation for myelodysplastic syndrome

AU - Shaffer, Brian C.

AU - Tallman, Martin

AU - Malone, Adriana K.

AU - Reshef, Ran

AU - Litzow, Mark R

AU - Liesveld, Jane

AU - Wiernik, Peter H.

AU - Ahn, Kwang Woo

AU - Hu, Zhen Huan

AU - Saber, Wael

AU - Nishihori, Taiga

AU - Kharfan-Dabaja, Mohamed A.

AU - Valcárcel, David

AU - Grunwald, Michael R.

AU - Fasan, Omotayo

AU - Copelan, Edward

AU - Wood, William Allen

AU - Rizzieri, David A.

AU - Bacher, Ulrike

AU - Hamilton, Betty

AU - Gerds, Aaron

AU - Kalaycio, Matt

AU - Sobecks, Ron

AU - William, Basem

AU - Saad, Ayman

AU - Costa, Luciano J.

AU - Cutler, Corey

AU - Alyea, Edwin

AU - Warlick, Erica

AU - Ustun, Celalettin

AU - Wirk, Baldeep Mona

AU - Sabloff, Mitchell

AU - Daly, Andrew

AU - Marks, David

AU - Gale, Robert Peter

AU - Olsson, Richard

AU - Miller, Alan M.

AU - Kamble, Rammurti

AU - Cortes, Jorge

AU - Popat, Uday

AU - Kindwall-Keller, Tamila L.

AU - Cahn, Jean Yves

AU - Savani, Bipin N.

AU - Vij, Ravi

AU - Maziarz, Richard

AU - Pavletic, Steven

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 3 109 /L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high ([[ampi]]ge; 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.

AB - Purpose To develop a system prognostic of outcome in those undergoing allogeneic hematopoietic cell transplantation (allo HCT) for myelodysplastic syndrome (MDS). Patients and Methods We examined 2,133 patients with MDS undergoing HLA-matched (n = 1,728) or -mismatched (n = 405) allo HCT from 2000 to 2012. We used a Cox multivariable model to identify factors prognostic of mortality in a training subset (n = 1,151) of the HLA-matched cohort. A weighted score using these factors was assigned to the remaining patients undergoing HLA-matched allo HCT (validation cohort; n = 577) as well as to patients undergoing HLA-mismatched allo HCT. Results Blood blasts greater than 3% (hazard ratio [HR], 1.41; 95% CI, 1.08 to 1.85), platelets 50 3 109 /L or less at transplantation (HR, 1.37; 95% CI, 1.18 to 1.61), Karnofsky performance status less than 90% (HR, 1.25; 95% CI, 1.06 to 1.28), comprehensive cytogenetic risk score of poor or very poor (HR, 1.43; 95% CI, 1.14 to 1.80), and age 30 to 49 years (HR, 1.60; 95% CI, 1.09 to 2.35) were associated with increased hazard of death and assigned 1 point in the scoring system. Monosomal karyotype (HR, 2.01; 95% CI, 1.65 to 2.45) and age 50 years or older (HR, 1.93; 95% CI, 1.36 to 2.83) were assigned 2 points. The 3-year overall survival after transplantation in patients with low (0 to 1 points), intermediate (2 to 3), high (4 to 5) and very high ([[ampi]]ge; 6) scores was 71% (95% CI, 58% to 85%), 49% (95% CI, 42% to 56%), 41% (95% CI, 31% to 51%), and 25% (95% CI, 4% to 46%), respectively (P [[ampi]]lt; .001). Increasing score was predictive of increased relapse (P , .001) and treatment-related mortality (P [[ampi]]lt; .001) in the HLA-matched set and relapse (P [[ampi]]lt; .001) in the HLA-mismatched cohort. Conclusion The proposed system is prognostic of outcome in patients undergoing HLA-matched and -mismatched allo HCT for MDS.

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