CYTOGENETIC ABNORMALITIES IN PRIMARY MYELODYSPLASTIC SYNDROME ARE HIGHLY PREDICTIVE OF OUTCOME AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

Allogeneic bone marrow transplantation (BMT) is the only curative ther apy available for patients with myelodysplastic syndrome (MDS). In an attempt to identify prognostic factors influencing outcome, we collect ed data retrospectively on 60 consecutive adult patients who had under gone BMT at our center for primary MDS or acute myelogenous leukemia e volving from preexisting primary MDS (sAML). Patients were divided int o subgroups according to cytogenetic abnormalities based on a recently described International MDS Workshop categorization system. The 7-yea r actuarial event-free survival (EFS), relapse rate, and nonrelapse mo rtality (NRM) for all patients were 29% (95% confidence interval [CI], 16% to 43%), 42% (CI, 24% to 67%). and 50% (CI, 37% to 64%), respecti vely. The EFS for the good; intermediate-. and poor-risk cytogenetic s ubgroups were 51% (CI, 30% to 69%), 40% (CI, 16% to 63%), and 6% (CI, 0% to 24%), respectively (P = .003). The corresponding actuarial relap se rates were 19% (CI, 6% to 49%), 12% (CI, 2% to 61%), and 82% (CI, 4 8% to 99%), respectively (P = .002) with no difference in NRM between the subgroups. Univariate analysis showed cytogenetic category, French -American-British (FAB) subtype, and graft-versus-host disease (GVHD) prophylaxis used to be predictive of relapse and EFS. In multivariate analysis, only the cytogenetic category was predictive of EFS, with th e relative risk of treatment failure for the good-, intermediate-, and poor-risk cytogenetic subgroups being 1.0. 1.5, and 3.5, respectively (P = .004). For adults with primary MDS and sAML, even after BMT. poo r-risk cytogenetics are predictive of an unfavorable outcome; novel tr eatment strategies will be required to improve results with allogeneic . BMT in this patient population. (C) 1998 by The American Society of Hematology.