Should Elderly Patients With Higher-Risk Myelodysplastic Syndromes Undergo Allogeneic Hematopoietic Stem Cell Transplantation?

Amer M Zeidan; Steven D Gore


Expert Rev Hematol. 2013;6(5):539-542. 

In This Article

Summary of Methods & Results

Koreth et al. conducted another Markov DA using an international database of 514 patients with primary MDS aged 60–70 years collected over two decades.[10] One hundred thirty-two patients underwent RIC-alloSCT (median age, 64 years, median follow-up in survivors 30 months) while 165 were treated with azanucleosides (median age 66 years, median follow-up in survivors 20 months). The IPSS scores were calculated at pretransplantation and at initiation of azanucleosides, respectively, while survival was measured from date of transplantation and date of initiation of azanucleosides, respectively. Non-anemic LR-MDS patients were treated with best supportive care (n = 123) while the 94 anemic LR-MDS patients were treated with growth factors.

The outcomes were assessed in Markov DA models in which patients could transition between three Markov health states (MHS): alive with MDS, alive post-RIC-alloSCT or dead.[10] The probabilities of transition between different MHS were estimated using the observed survival data of the original cohorts. Patients could transition between MHS in three-monthly intervals. Patients were not censored at therapy cross-over therefore accounting for salvage therapy. LE was estimated as the area under the survival curve; adjustment for quality of survival was made to calculate quality-adjusted LE (QALE). Monte-Carlo Simulation was used to plot Kaplan–Meier survival curves with a modeled 10-year follow-up. Results were validated by comparing them with the primary data.[10]

The investigators found that for IPSS LR-MDS, RIC-alloSCT resulted in a significantly lower LE (38 vs 77 months) and QALE (35 vs 47 months) compared with non-transplantation strategies. By contrast, a benefit in LE (36 vs 28 months) and QALE (33 vs 15 months) was achieved with RIC-alloSCT for IPSS HR-MDS in comparison with non-transplantation therapies including azanucleosides. Across variable plausible assumptions, sensitivity analyses confirmed these conclusions.[10]