Multicenter Validation Study of a Transplantation-Specific Cytogenetics Grouping Scheme for Patients with Myelodysplastic Syndromes

Cytogenetics are an important prognostic factor for patients with MDS. However, existing cytogenetics grouping schemes are based on patients treated with supportive care, and may not be optimal for patients undergoing allogeneic stem cell transplantation (SCT). We previously proposed an SCT-specific cytogenetics grouping scheme for patients with MDS and AML arising from MDS, based on an analysis of patients transplanted at Dana-Farber Cancer Institute/Brigham and Women’s Hospital. Under this scheme, abnormalities of chromosome 7 and complex karyotype are considered adverse-risk, while all others are considered standard-risk. In the present retrospective study, we validated this scheme on an independent multicenter cohort of 546 patients. Adverse cytogenetics was the strongest prognostic factor for outcome in this cohort. Four-year relapse-free and overall survival were 42% and 46%, respectively, in the standard risk group, versus 21% and 23% in the adverse group (p<0.0001 for both comparisons). This grouping scheme retained its prognostic significance irrespective of patient age, disease type, prior leukemogenic therapy, and conditioning intensity. Therapy-related disease was not associated with increased mortality in this cohort, after taking cytogenetics into account. We propose that this SCT-specific cytogenetics grouping scheme be used for patients with MDS or AML arising from MDS who are considering or undergoing SCT.