A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes:: delayed transplantation for low-risk myelodysplasia is associated with improved outcome
A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes:: delayed transplantation for low-risk myelodysplasia is associated with improved outcome
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DOI：
10.1182/blood-2004-01-0338
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发表时间：
2004-07-15
期刊：
影响因子：
20.3
通讯作者：
Horowitz, MM
中科院分区：
文献类型：
--
作者：
Cutler, CS;Lee, SJ;Horowitz, MM
骨髓移植（BMT）可以治愈骨髓增生异常综合征（MDS），虽然移植具有显着的发病率和死亡率的风险。由于HLA配型骨髓移植治疗MDS的最佳时机尚不清楚，我们构建了一个马尔可夫模型来研究新诊断的MDS的3种移植策略：诊断时移植，白血病进展时移植，以及诊断后但在白血病进展前的一段时间内移植。使用移植和非移植登记处的个体患者风险评估数据对所有4个国际预后评分系统（IPSS）风险组进行分析，并调整生活质量（QoL）。对于低IPSS组和中IPSS-1组，延迟移植使总生存率最大化。白血病转化前移植比白血病进展时移植与更大的生命年数相关。在一组40岁以下的患者中，延迟移植的生存优势更为明显。对于中间-2和高IPSS组，诊断时移植最大化总生存期。当QoL调整被纳入时，最佳移植策略没有变化。对于低风险和中风险1型骨髓移植，延迟骨髓移植与最长预期寿命相关，而对于中风险2型和高风险疾病，立即移植与最长预期寿命相关。(C)2004年，美国血液学会。
Bone marrow transplantation (BMT) can cure myelodysplastic syndrome (MDS), although transplantation carries significant risks of morbidity and mortality. Because the optimal timing of HLA-matched BMT for MDS is unknown, we constructed a Markov model to examine 3 transplantation strategies for newly diagnosed MDS: transplantation at diagnosis, transplantation at leukemic progression, and transplantation at an interval from diagnosis but prior to leukemic progression. Analyses using individual patient risk-assessment data from transplantation and non transplantation registries were performed for all 4 International Prognostic Scoring System (IPSS) risk groups with adjustments for quality of life (QoL). For low and intermediate-1 IPSS groups, delayed transplantation maximized overall survival. Transplantation prior to leukemic transformation was associated with a greater number of life years than transplantation at the time of leukemic progression. In a cohort of patients under the age of 40 years, an even more marked survival advantage for delayed transplantation was noted. For intermediate-2 and high IPSS groups, transplantation at diagnosis maximized overall survival. No changes in the optimal transplantation strategies were noted when QoL adjustments were incorporated. For low- and intermediate-1-risk MDS, delayed BMT is associated with maximal life expectancy, whereas immediate transplantation for intermediate-2- and high-risk disease is associated with maximal life expectancy. (C) 2004 by The American Society of Hematology.