WHO classification and WPSS predict posttransplantation outcome in patients with myelodysplastic syndrome:: a study from the Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

We evaluated the impact of World Health Organization (WHO) classification and WHO classification-based Prognostic Scoring System (WPSS) on the outcome of patients with myelodysplastic syndrome (MDS) who underwent allogeneic stem cell transplantation (allo-SCT) between 1990 and 2006. Five-year overall survival (OS) was 80% in refractory anemias, 57% in refractory cytopenias, 51% in refractory anemia with excess blasts 1 (RAEB-1), 28% in RAEB-2, and 25% in acute leukemia from MDS (P =.001). Five-year probability of relapse was 9%, 22%, 24%a, 56%, and 53%, respectively (P <.001). Five-year transplant-related mortality (TRM) was 14%,39%,38%,34%, and 44%, respectively (P =.24). In multivariate analysis, WHO classification showed a significant effect on OS (P =.017) and probability of relapse (P =.01); transfusion dependency was associated with a reduced OS (P=.01) and increased TRM (P =.037), whereas WPSS showed a prognostic significance on both OS (P =.001) and probability of relapse (P <.001). In patients without excess blasts, multilineage dysplasia and transfusion dependency affected OS (P =.001 and P =.009, respectively), and were associated with an increased TRM (P =.013 and P =.031, respectively). In these patients, WPSS identified 2 groups with different OS and TRM. These data suggest that WHO classification and WPSS have a relevant prognostic value in posttransplantation outcome of MDS patients.