Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 34, Issue 16, Pages 1864-+Publisher
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2015.65.0515
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Funding
- Public Health Service Grant from the National Cancer Institute (NCI) [U24-CA76518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases (NIAID)
- NHLBI [5U01HL069294]
- NCI
- Health Resources and Services Administration (HRSA/DHHS) [HHSH234200637015C]
- Office of Naval Research [N00014-06-1-0704, N00014-08-1-0058]
- Allos, Inc.
- Amgen, Inc.
- Angioblast
- Be the Match Foundation
- Blue Cross and Blue Shield Association
- Buchanan Family Foundation
- CaridianBCT
- Celgene Corporation
- CellGenix, GmbH
- Children's Leukemia Research Association
- Fresenius-Biotech North America, Inc.
- Gamida Cell Teva Joint Venture Ltd.
- Genentech, Inc.
- Genzyme Corporation
- GlaxoSmithKline
- Kiadis Pharma
- Leukemia & Lymphoma Society
- Medical College of Wisconsin
- Millennium Pharmaceuticals, Inc.
- Milliman USA, Inc.
- Miltenyi Biotec, Inc.
- National Marrow Donor Program
- Optum Healthcare Solutions, Inc.
- Otsuka America Pharmaceutical, Inc.
- Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix, Inc.
- Swedish Orphan Biovitrum
- THERAKOS, Inc.
- Wellpoint, Inc.
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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 10(9)/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 (>= 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 < .001). Increasing score was predictive of increased relapse (P < .001) and treatment-related mortality (P < .001) in the HLA-matched set and relapse (P < .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. (C) 2016 by American Society of Clinical Oncology
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