Can molecular data improve prognostication in MDS patients undergoing HSCT?

In the prognostication of patients with myelodysplastic syndromes (MDS) undergoing hematopoietic stem cell transplant (HSCT), findings from a large, international study showed that molecular data improved the prediction of overall survival (OS) modestly.

Dr Carmelo Gurnari (Cleveland Clinic, OH, USA) and co-investigators conducted a real-world study among 416 participants with MDS to assess the links between transplantation and the Molecular International Prognostic Scoring System (IPSS-M) [1]. In the study cohort, 36% of the participants underwent the transplant upfront and 85% of the participants used hypomethylating agents as bridge therapy.

The IPSS-R, a prognostic scoring system that uses haematological and cytogenetic parameters, not including molecular information, stratified participants according to risk: very low (6%), low (17%), intermediate (19%), high (26%), and very high (32%) risk. The calculated IPSS-M scores, which differs from the IPSS-R by adding molecular data, resulted in a significant redistribution of participants with respect to these risk categories: very low (27%), low (18%), moderately low (14%), moderately high (15%), high (10%), and very high (16%). Furthermore, the c-index for overall survival was 0.583 for the IPSS-M and 0.547 for the IPSS-R, suggesting that the IPSS-M is slightly better at predicting OS outcomes than the IPSS-R. The c-index of IPSS-M for OS was lower than the observed c-indexes in the study by Bernard et al. and comparable with existing specific HSCT MDS risk scores [2].

1. 1. Gurnari C, et al. Outcome prediction in patients with myelodysplastic syndrome undergoing hematopoietic cell transplant in the molecular era of IPSS-M. OS17-05, European Society for Blood and Marrow Transplantation (EBMT) 49^th annual meeting, 23–26 April 2023, Paris, France.
   2. Bernard E, et al. N Engl J Med Evid. 2022;1(7).

 

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Posted on 3 May, 202314 May, 2023