Premium
Optimal timing of allogeneic hematopoietic stem cell transplantation in patients with myelodysplastic syndrome
Author(s) -
Alessandrino Emilio Paolo,
Della Porta Matteo G.,
Malcovati Luca,
Jackson Christopher H,
Pascutto Cristiana,
Bacigalupo Andrea,
van Lint Maria Teresa,
Falda Michele,
Bernardi Massimo,
Onida Francesco,
Guidi Stefano,
Iori Anna Paola,
Cerretti Raffaella,
Marenco Paola,
Pioltelli Pietro,
Angelucci Emanuele,
Oneto Rosi,
Ripamonti Francesco,
Rambaldi Alessandro,
Bosi Alberto,
Cazzola Mario
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23458
Subject(s) - medicine , transplantation , international prognostic scoring system , myelodysplastic syndromes , hematopoietic stem cell transplantation , hematology , life expectancy , oncology , disease , intensive care medicine , population , bone marrow , environmental health
Allogeneic hematopoietic stem cell transplantation (HSCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non‐negligible morbidity and mortality. Registry studies have shown that advanced disease stage at transplantation is associated with inferior overall survival. To define the optimal timing of allogeneic HSCT, we carried out a decision analysis by studying 660 patients who received best supportive care and 449 subjects who underwent transplantation. Risk assessment was based on both the International Prognostic Scoring System (IPSS) and the World Health Organization classification‐based Prognostic Scoring System (WPSS). We used a continuous‐time multistate Markov model to describe the natural history of disease and evaluate the effect of allogeneic HSCT on survival. This model estimated life expectancy from diagnosis according to treatment policy at different risk stages. Relative to supportive care, estimated life expectancy increased when transplantation was delayed from the initial stages until progression to intermediate‐1 IPSS‐risk or to intermediate WPSS‐risk stage, and then decreased for higher risks. Modeling decision analysis on WPSS versus IPSS allowed better estimation of the optimal timing of transplantation. These observations indicate that allogeneic HSCT offers optimal survival benefits when the procedure is performed before MDS patients progress to advanced disease stages. Am. J. Hematol. 88:581–588, 2013. © 2013 The Authors Americanl Journal of Hematology Published by Wiley Periodicals, Inc.