Clinical Prognostic Analysis Of Allogeneic Hematopoietic Stem Cell Transplantation In 189 Patients With Myelodysplastic Syndrome

Myelodysplastic syndrome(MDS)is a group of clonal diseases derived from hematopoietic stem cells.The clinical features of MDS are that the patient's bone marrow hyperplasia is active but the peripheral blood cells are reduced by one or more lines.Ineffective hematopoiesis in the bone marrow caused by dysplasia of bone marrow in one or more blood cells and high-risk conversion to acute myeloid leukemia(AML).At present,there are many methods for MDS treatment,but allogeneic hematopoietic stem cell transplantation(allo-HSCT)is the only method that can cure MDS,but because of the large heterogeneity of MDS,the outcome after treatment of different patients are also very different.The median survival time can be less than 6months and the longest can be more than 5 years.Although the effectiveness and safety of allo-HSCT have greatly improved in the past 20 years,but the relapse after transplantation and the treatment-related morality are still the major threats faced by patients.Objective:Because the outcome of different MDS patients after allo-HSCT treatment is very different.So this article mainly discusses the clinical prognostic factors of allo-HSCT in 189 Patients with MDS,and provides powerful treatment strategy formulation and outcome assessment for patients with MDS undergoing allo-HSCT.Method:To retrospectively analyze the clinical features and prognosis of 189 patients with MDS undergoing allo-HSCT in our hospital from December 1997 to December 2017.We will use Kaplan-Meier to calculate The overall survival(OS),relapse-rate(RR),and non-relapse mortality(NRM).Using the log-rank test to analyze univariate.The multivariate analysis was performed by the Cox regression model to determine the impact of donor type(The human leukocyte antigen(HLA)matched sibling donor is defined as HLA matched donor,and the HLA unrelated donor and mismatched sibling donor are defined as HLA mismatched donors),.hematopoietic cell transplantation-specific comorbidity index(HCT-CI),the percentage of bone marrow blast cells and pretreatment plan on the prognosis of patients.Result:The median survival time time of 189 patients was 26(0-243)months.Granulocyte and platelet implantation:Granulocytes were not implanted successfully in eight patients,and the median time is 14(4-32)days.Platelets were not implanted in 30patients and the median time is 20(5-152)days.The occurrence of acute graft versus host disease(aGVHD):Eighty-eight(46%)of the 189 patients developed aGVHD,of which 74(39.2%)has grade II-IV aGVHD.The five-year OS,cumulative RR,and NRM were 59.6%,21.7%,and 28.1%respectively.Univariate analysis showed that donor type(HLA matched donor:68.3%,HLA mismatch donor:46.2%,P=0.001),HCT-CI(<2:70.5%,?2:26.4%,P<0.001),percentage of bone marrow blast cells(<10%:68.8%,?10%:58.8%,P=0.041)are related to the patient's OS;the percentage of bone marrow blast cells(<10%:6.4%,?10%:20.1%,P<0.001)can predicte the RR in patients undergoing allo-HSCT;donor type(HLA-matched donor:20.8%,HLA mismatch donor:38.7%,P=0.04?HCT-CI(<2:20.9%,?2:67.6%,P<0.001)affected patients'NRM.Multivariate analysis showed that the donor type(HR 1.967,95%CI1.239-3.122,P=0.04),HCT-CI(HR 2.863,95%CI 1.727-4.744,P<0.001)was the significant predictor of OS.The percentage of bone marrow blast cells(HR 21.997,95%CI 2.607-185.637,P=0.005)was related to RR.The donor type(HR 2.180,95%CI1.246-3.815,P=0.006),HCT-CI(HR 3.811,95%CI 2.150-6.754,P<0.001)was a risk factor for NRM.Conclusion:This article reviews the prognosis of patients with MDS undergoing allo-HSCT in the past 20 years and explores the factors that have a significant impact on the prognosis.The results show that donor type,HCT-CI and the percentage of bone marrow blast cells are the important prognostic factors in patients with MDS undergoing allo-HSCT.When the transplantation is performed,the HLA sibling donor should be preferred.Patients with higher HCT-CI scores tend to have poor prognosis.Reducing the initial cell burden of pretransplantation MDS patients can effectively improve the patient's prognosis.The comprehensive evaluation of donor type,HCT-CI,and the percentage of bone marrow blast cells the patients with MDS before transplantation is conducive to the judgment of the patient's outcome after transplantation and the choice of the best treatment plan.