Myelodysplastic syndrome
International prognosis scoring system
| Prognosis factors | Score | ||||
| 0 | 0,5 | 1 | 1,5 | 2,0 | |
| Cytopeniasaa | 0 – 1 | 2 – 3 | |||
| Karyotypeb | good | intermediate | poor | ||
| % marrow blasts | < 5 | 5 – 10 | 11 – 20 | 21 – 30 | |
Median survival
| Risk category | Combined score | Median survival if ≥ 60 years |
|---|---|---|
| Low | 0 | 11,8 years |
| Intermediate – 1 | 0,5 – 1,0 | 5,2 years |
| Intermediate – 2 | 1,5 – 2,0 | 1,8 years |
| High | ≥ 2,5 | 0,3 years |
| aCytopenias: | |
|
neutrophils platelets hemoglobin |
< 1.5 x 109/L < 100 x 109/L < 100g/L |
| bKaryotype: | |
|
Good Poor Intermediate |
normal, -Y, del (5q), del (20q) complex (≥ 3 abnormalitiess) or abnormal chromosome 7 others abnormalities |
Indications for allogeneic transplant
- IPSS score ≥ Int-2: proceed to transplant if donor is available (related or unrelated).
- IPSS score Int-1:
- Transplant if HLA 6/6 identical sibling transplant available and absence of significant co-morbidities.
- Unrelated donor transplant only if neutrophils (ANC) < 500 or patient is transfusion dependent for platelets or RBCs after failure of therapy with growth factors or other available therapy (e. g.: lenalidomide, decitabine or other).
- Low IPSS score:
- Transplant if severe neutropenia (ANC < 500 despite G-CSF) or if transfusion dependent for platelets or RBCs (despite Eprex).
- Secondary MDS: if myelodysplasia is clearly secondary to either chemotherapy or radiation therapy, the patient is eligible to transplant regardless of the IPSS score.
5q- syndrome
- Patients with a 5q- syndrome and an IPSS score < Int-2 should receive lenalidomide as initial therapy (if available) before considering transplant.
Age limitation and transplantation
- Up to 65 years for sibling transplant.
- Up to 60 years for unrelated transplant if no prior chemotherapy: requires an 8/8 molecular match for A, B, DRB1 antigens and a serologic match for C.
- Ad 55 ans pour donneur non apparenté si chimiothérapie au préalable.
Blasts in bone marrow
- ≤ 0% blasts in a bone marrow aspirate performed within 14 days of the first conditioning regimen day.
Myeloablative vs nonmyeloablative transplant
- Comparative studies have shown that long term survival are similar, but the risk of relapse is higher after nonmyeloablative transplant, whereas the risk of transplant related mortality (TRM) is higher after myeloablative transplant.
- Ad 60 years of age, we recommend myeloablative transplant except in presence of significant co-morbidity or if the patient has already had autologous transplant.
- 60-65 years: we recommend nonmyeloablative transplant except if the patient has excellent overall condition with disease at high risk of relapse.
