IPSS-R及WPSS移植前评估对异基因造血干细胞移植治疗骨髓增生异常综合征患者预后意义的研究

OBJECTIVE: This study aimed to explore the prognostic value of the revised international prognostic scoring system (IPSS-R) and the WHO prognostic scoring system (WPSS) in patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: The clinical data of 184 patients with MDS who received allo-HSCT from July 2016 to June 2019 were retrospectively analyzed. IPSS-R and WPSS were performed at diagnosis and before transplantation. The prognostic values of IPSS-R and WPSS and potential risk factors were explored. RESULTS: With a median follow-up of 21.9 (0.5–47.5) months, the two-year overall survival (OS) and progression-free survival (PFS) rates were (75.1±3.4)％ and (71.6±3.6)％, respectively. The two-year cumulative relapse rate and nonrelapse mortality rate were (11.9±0.1)％ and (16.5±0.1)％, respectively. There were no significant differences in OS and PFS between the IPSS-R ≤3.5 and >3.5 groups at diagnosis (P＝0.409; P＝0.724). No significant differences in OS and PFS between the WPSS ≤2 and >2 groups (P＝0.426; P＝0.726) were observed as well. When the patients were reevaluated before transplantation, the OS and PFS of the IPSS-R ≤3.5 group were significantly better than >3.5 group［OS: (88.6±4.1)％ vs (65.8±5.3)％, P＝0.003; PFS: (87.6±4.2)％ vs (60.5±5.8)％, P＝0.002］. However, there were no significant differences in OS and PFS among the WPSS ≤2 and >2 groups (P＝0.584; P＝0.565). In addition, the OS and PFS of the improved group based on IPSS-R were significantly better than those of the unimproved group before transplantation［OS: (83.8±4.6)％ vs (69.3±5.8)％, P＝0.027; PFS: (82.8±4.4)％ vs. (64.0±7.2)％, P＝0.006］. Multivariate analysis indicated that a pretransplant IPSS-R of >3.5 (P＝0.021, HR＝2.510, 95％ CI 1.151–5.476) and TP53 mutation (P＝0.047, HR＝2.460, 95％ CI 1.014–5.971) were independent risk factors for OS, whereas a pretransplant IPSS-R of >3.5 (P＝0.017, HR＝2.457, 95％ CI 1.175–5.141) and pretransplant cytogenetic poor and very poor (P＝0.008, HR＝2.765, 95％ CI 1.305–5.856) were independent risk factors for PFS. CONCLUSION: A pretransplantation evaluation of IPSS-R could help determine the prognosis of patients with MDS undergoing allo-HSCT. In addition, patients with improved IPSS-R scores before undergoing allo-HSCT had a better prognosis.