Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: A GITMO study

Emilio Paolo Alessandrino, Matteo Giovanni Della Porta, Andrea Bacigalupo, Luca Malcovati, Emanuele Angelucci, Maria Teresa Van Lint, Michele Falda, Francesco Onida, Massimo Bernardi, Stefano Guidi, Barbarella Lucarelli, Alessandro Rambaldi, Raffaella Cerretti, Paola Marenco, Pietro Pioltelli, Cristiana Pascutto, Rosi Oneto, Laura Pirolini, Renato Fanin, Alberto Bosi

Research output: Contribution to journalArticle

Abstract

Background: Transfusion-dependency affects the natural history of myelodysplastic syndromes. Secondary iron overload may concur to this effect. The relative impact of these factors on the outcome of patients with myelodysplastic syndrome receiving allogeneic stem-cell transplantation remains to be clarified. Design and Methods: We retrospectively evaluated the prognostic effect of transfusion history and iron overload on the post-transplantation outcome of 357 patients with myelodysplastic syndrome reported to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) registry between 1997 and 2007. Results: Transfusion-dependency was independently associated with reduced overall survival (hazard ratio=1.48, P=0.017) and increased non-relapse mortality (hazard ratio=1.68, P=0.024). The impact of transfusion-dependency was noted only in patients receiving myeloablative conditioning (overall survival: hazard ratio=1.76, P=0.003; non-relapse mortality: hazard ratio=1.70, P=0.02). There was an inverse relationship between transfusion burden and overall survival after transplantation (P=0.022); the outcome was significantly worse in subjects receiving more than 20 red cell units. In multivariate analysis, transfusion-dependency was found to be a risk factor for acute graft-versus-host disease (P=0.04). Among transfusion-dependent patients undergoing myeloablative allogeneic stem cell transplantation, pre-transplantation serum ferritin level had a significant effect on overall survival (P=0.01) and non-relapse mortality (P=0.03). This effect was maintained after adjusting for transfusion burden and duration, suggesting that the negative effect of transfusion history on outcome might be determined at least in part by iron overload. Conclusions: Pre-transplantation transfusion history and serum ferritin have significant prognostic value in patients with myelodysplastic syndrome undergoing myeloablative allogeneic stem cell transplantation, inducing a significant increase of non-relapse mortality. These results indicate that transfusion history should be considered in transplantation decision-making in patients with myelodysplastic syndrome.

Original languageEnglish
Pages (from-to)476-484
Number of pages9
JournalHaematologica
Volume95
Issue number3
DOIs
Publication statusPublished - Mar 2010

Keywords

  • Myelodysplastic syndromes
  • Secondary iron overload
  • Transfusion-dependency

ASJC Scopus subject areas

  • Hematology

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    Alessandrino, E. P., Della Porta, M. G., Bacigalupo, A., Malcovati, L., Angelucci, E., Van Lint, M. T., Falda, M., Onida, F., Bernardi, M., Guidi, S., Lucarelli, B., Rambaldi, A., Cerretti, R., Marenco, P., Pioltelli, P., Pascutto, C., Oneto, R., Pirolini, L., Fanin, R., & Bosi, A. (2010). Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: A GITMO study. Haematologica, 95(3), 476-484. https://doi.org/10.3324/haematol.2009.011429