Prophylactic Intervention for Relapse after Allogeneic Peripheral Blood Stem Cell Transplantation Improve the Survival of adult patients with Myelodysplastic Syndrome based on IPSS-M stratification

Abstract Allogeneic hematopoietic stem cell transplantation represents a curative modality for patients with myelodysplastic syndrome (MDS), yet relapse risk persists. The prognostic performances of the Revised International Prognostic Scoring System (IPSS-R) and the Molecular International Prognostic Scoring System (IPSS-M) for 129 MDS patients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) were evaluated. Using IPSS-M, 29.5% of patients were reclassified to a higher risk and 14.0% to a lower risk compared to IPSS-R. The two-year recurrence-free survival (RFS) and overall survival (OS) post-transplant were similar across IPSS-R groups, but significantly lower in the very-high risk category with IPSS-M (P=0.005 for RFS; P=0.014 for OS). Multivariate analysis revealed that patient age (P=0.008), very-high risk in IPSS-M (P=0.002), Karnofsky Performance Status score (P=0.003), and Grade 3-4 acute graft-versus-host disease (P=0.014) were independent factors for OS and RFS. Only very-high risk category in IPSS-M was the independent factor affecting cumulative incidence of relapse (P=0.003). Prophylactic interventions for relapse significantly decreased the risk of relapse (P=0.003) and increased the survival of patients in the very-high risk category (P=0.002 for OS, P=0.006 for RFS). The study suggested that the IPSS-M system could identify the high relapse risk patients post-transplant who may benefit from early prophylactic interventions.