COMPLEX KARYOTYPE CHANGES ARE THE STRONGEST PREDICTOR OF OUTCOME OF ALLOGENEIC TRANSPLANTATION IN MYELODYSPLASTIC SYNDROME

Background

Introduction: Complex karyotype has been recently reported as one of the predictors of poor outcome of allogeneic transplantation in patients with myelodysplastic syndrome (MDS). Current opinions challange transplantation as a curative option in these patients.

Aims
To evaluate impact of complex karyotype changes of MDS in setting of allogeneic stem cell transplantation

Methods

Patients and methods: We evaluated all consecutive patients with all stages of MDS transplanted at our center from 2007-2014. Patients parameters, demographic data, disease status, pretransplant remission status, type of transplantation and karyotype has been evaluated as possible factors influencing outcome of transplantation.

Results

Results: Overall 22 patients (12 males, 10 females, median age 56 years, 32-66 years) were analysed. Disease status was as follows: 12/22 were MDS related AML, 4/22 RAEB-2, 3/22 RAEB-1 and 3/22 RA or RCMD. Majority of patients (20/22) underwent transplant from matched unrelated donor, 2/22 had sibling donor. Conditioning was intended myeloablative in 13/22 patients and reduced intensity in 9/22. 14 patients reached hematologic CR before transplant. Five (5/22) patients had complex karyotype changes. The median follow-up was 3 months. Median overall survival was not reached, survival at 5 years was 56%. The strongest predictors of outcome were: CR before transplant (median survival 4.5 months vs. not reached, p=0.0997, trend only), stage of the disease (AML and RAEB-2 vs. others, median survival 18 months vs. not reached, p=0.0361) and komplex karyotype changes (meadian survival 4.5 months versus not reached p=0.0044).

Summary

Conclusion: Complex karyotype changes, disease stage and remission status are probably the most singificant factors which influence the outcome of allogeneic transplantation in MDS. The possibility of transplant for these patients is a matter for debate since the outcome remains dismal.

Keyword(s): Allogeneic hematopoietic stem cell transplant, Complex aberrant karyotype, Myelodysplasia

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