MDS Transplant Outcomes Improved Little by Pretransplant Downstaging

Interventions to downstage disease before transplant in patients with myelodysplastic syndromes (MDS) produce little improvement in post-transplant outcomes. Results from a retrospective analysis were recently published in Blood.

“The results show a limited benefit of [revised International Prognostic Scoring System (IPSS-R)] score downstaging or reduction of [bone marrow] blasts after chemotherapy and no benefit for [hypomethylating agents (HMAs)] or other treatments,” wrote lead author Christof Scheid, MD, PhD, of the University of Cologne.

The analysis comprised 1482 patients with MDS. Using transplant registry data from these patients, researchers calculated IPSS-R scores and entered them into a multivariable Cox model. This model recorded IPSS-R scores at MDS diagnosis, measured how scores changed with the downstaging treatment before transplant, and determined if downstaging affected transplant outcomes.

For patients who did not have downstaging treatment before transplant, pretransplant changes in IPSS-R score had no effect on transplant outcomes. Patients who received chemotherapy before transplant saw improved IPSS-R scores at time of transplant and had moderately superior transplant outcomes. The patients who received HMAs or other therapies and saw improved IPSS-R scores before transplant had no benefit to transplant outcomes.

When progression occurred in patients after chemotherapy, HMAs, or other therapies, the transplant outcomes were worse than in patients with no prior treatment.

The investigators had similar findings to the IPSS-R score results when they evaluated disease by the change in bone marrow blast presence between diagnosis and transplant in patients.

Dr. Scheid wrote in conclusion that these results “question the role of prior therapy in patients with MDS scheduled for transplantation.” He added, however, that “[t]he model-based survival estimates should help inform decision-making for both doctors and patients.”

Reference

Scheid C, Eikema DJ, van Gelder M, et al. Does IPSS-R downstaging before transplantation improve the prognosis of patients with myelodysplastic neoplasms? Blood. 2024;144(4):445-456. doi:10.1182/blood.2023022273