Allogeneic stem cell transplant in myelodysplastic syndrome-factors impacting survival

Objectives The primary aim of this study was to evaluate survival outcomes following allo-HCT in myelodysplastic syndrome (MDS), and the secondary aim was to study variables impacting survival. Methods This analysis describes patient characteristics, treatment, and outcomes in 125 consecutive adult patients with MDS transplanted from 2005 to 2018. Results The median age was 61 years, and median follow-up in patients alive at last follow-up was 29 months. The 2-year OS and RFS were 39% (95%CI 30%-48%) and 35.3% (95% CI: 27%-44%), respectively. Transfusion dependence, high-risk cytogenetics, and high serum ferritin were independent risk factors for death. The cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) at 2 years were 23% and 41.6%, respectively. High serum ferritin was significantly associated with NRM. There was no association between the percentage of bone marrow blasts (either at diagnosis or at pretransplant evaluation), on relapse or survival. Induction chemotherapy did not offer any survival advantage in MDS RAEB-2 patients compared to cytoreduction with azacytidine alone. Conclusion Our results highlight the importance of karyotype on survival after allo-HCT and identify serum ferritin and transfusion dependence as important surrogate markers of outcome. In addition, our results demonstrate the efficacy of azacytidine for pretransplant cytoreduction.