Allogeneic bone marrow transplantation for myelodysplastic syndrome: outcomes analysis according to IPSS score

The objective of our analysis was to determine the post-transplantation outcomes for patients with myelodysplastic syndrome (MDS) according to their International Prognostic Scoring System (IPSS) risk categorization. Data for all MDS patients transplanted at our institution from 1981-1996 were reviewed. Multivariate analysis was used to determine factors predictive for non-relapse mortality, relapse, and disease-free survival. A total of 251 MDS patients (median age = 38 years) were transplanted from 1981-1996. The overall disease-free survival rate was 40%, with an 18% relapse rate. Older age, increasing disease duration, mismatched donors, male gender, and therapy-related MDS were factors that significantly enhanced the likelihood of non-relapse mortality. Increasing disease duration, morphology, and cytogenetics were significant in predicting relapses. Increasing age, disease morphology, and cytogenetics were significant in determining disease-free survival. IPSS score was found to correlate significantly with relapse and disease-free survival. The 5-year disease-free survival was 60%, 36%, and 28% for low and intermediate-1 risk, intermediate-2 risk, and high risk patients, respectively. We conclude that IPSS score may be used to predict relapse and disease-free survival in MDS patients undergoing allogeneic transplantation. Allogeneic transplantation may be recommended for patients with intermediate-1, intermediate-2, or high risk MDS.