Optimal timing of allogeneic hematopoietic stem cell transplantation in patients with myelodysplastic syndrome

Emilio Paolo Alessandrino, Matteo G Della Porta, Luca Malcovati, Christopher H. Jackson, Cristiana Pascutto, Andrea Bacigalupo, Maria Teresa van Lint, Michele Falda, Massimo Bernardi, Francesco Onida, Stefano Guidi, Anna Paola Iori, Raffaella Cerretti, Paola Marenco, Pietro Pioltelli, Emanuele Angelucci, Rosi Oneto, Francesco Ripamonti, Alessandro Rambaldi, Alberto BosiMario Cazzola

Research output: Contribution to journalArticlepeer-review

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non-negligible morbidity and mortality. Registry studies have shown that advanced disease stage at transplantation is associated with inferior overall survival. To define the optimal timing of allogeneic HSCT, we carried out a decision analysis by studying 660 patients who received best supportive care and 449 subjects who underwent transplantation. Risk assessment was based on both the International Prognostic Scoring System (IPSS) and the World Health Organization classification-based Prognostic Scoring System (WPSS). We used a continuous-time multistate Markov model to describe the natural history of disease and evaluate the effect of allogeneic HSCT on survival. This model estimated life expectancy from diagnosis according to treatment policy at different risk stages. Relative to supportive care, estimated life expectancy increased when transplantation was delayed from the initial stages until progression to intermediate-1 IPSS-risk or to intermediate WPSS-risk stage, and then decreased for higher risks. Modeling decision analysis on WPSS versus IPSS allowed better estimation of the optimal timing of transplantation. These observations indicate that allogeneic HSCT offers optimal survival benefits when the procedure is performed before MDS patients progress to advanced disease stages.

Original languageEnglish
Pages (from-to)581-588
Number of pages8
JournalAmerican Journal of Hematology
Volume88
Issue number7
DOIs
Publication statusPublished - Jul 2013

ASJC Scopus subject areas

  • Hematology

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