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Allogenic Stem Cell Transplantation for MDS

Allogenic Stem Cell Transplantation for MDS. 林建廷 April 28, 2008. Indicated?. IPSS for MDS (FAB classification) Greenberg P et al . International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100)

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Allogenic Stem Cell Transplantation for MDS

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  1. Allogenic Stem Cell Transplantation for MDS 林建廷 April 28, 2008

  2. Indicated? • IPSS for MDS (FAB classification) • Greenberg P et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100) • WPSS for MDS (WHO classification) • Germany. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007; 25: 3503-3510.

  3. Free from

  4. Indicated? • IPSS for MDS (FAB classification) • Greenberg P et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997; 89: 2079-2088. (Erratum in Blood 1998; 91: 1100) • WPSS for MDS (WHO classification) • Germany. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007; 25: 3503-3510.

  5. OS Risk of AML Time-dependent WPSS

  6. Both from IPSS and WPSS, the estimated OS is about 2 yrs, and 5-yr survival probability is about 15-25% • Therefore, further treatment other than BSC is indicated. • ATG/CsA • Azacitidine/Decitabine • Allo-SCT

  7. Will respond to immunosuppression? • NIH. A simple method to predict response to immunosuppressive therapy in patients with myelodysplastic syndrome. Blood. 2003; 102: 3025-3027. • ATG + CsA (regardless of blast percentage)

  8. HCT-Comorbidity index(HCT-CI) from Fred Hutchinson CRC • Fred Hutchinson CRC. Hematopoietic cell transplantation-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005; 106: 2912-2919 • Ablative (n=761) vs nonablative (n=294) • Related (58%) vs unrelated (42%) • PB(71%) vs Marrow(29%) • GVHD prophylaxis with CsA/MTX(82%) or CsA/MMF(18%) • GVHD tx with steroid or reinstitution of CsA • Infection prophylaxis with Fluconazole, (Ceftazidime or Ciproxin), (Baktar or Dapsone), Acyclovir if sero(+)

  9. Causes of Non-relapse Mortality(NRM) • N=122 • Pulmonary toxicities (24%) • GVHD (11%) • Infections (45%) • Infection + GVHD (18%) • Infection – GVHD (27%) • Others (20%) • HCT-CI did not take into consideration including age, underlying disease and type of transplantation

  10. 50-point Pretransplantation Assessment of Mortality (PAM) Score • Predict 2-yr Allo-SCT mortality (any cause) • Fred Hutchinson CRC. A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Intern Med. 2006; 144: 407-414 • n=2802 • Predict survival within 2 yrs

  11. Age Donor type Dz risk Conditioning regimen FEV1 DLCO Cre GPT

  12. Predict AML/MDS allo-SCT Risk/Benefit • Fred Hutchinson CRC. Comorbidity and disease status-based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007; 25: 4246-4254

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