Prognostic risk factors relevant for HSCT eligibility, for outcome after HSCT, and for optimal timing of the procedure
| Prognostic risk factor . | Tools to measure risk factors in patients with MDS . | Outcome after HSCT in patients with MDS . |
|---|---|---|
| Patient-related features | ||
| Age | Calendar, age-adjusted IPSS-R | Worse outcome in elderly patients |
| Performance status | KS | KS >80% associated with better outcome |
| Comorbidities | HCT-CI | Low CI associated with better outcome |
| Disease-related features | ||
| % of marrow blasts | IPSS-R | <5% blasts associated with better outcome |
| Cytogenetics | IPSS-R | Poor-risk cytogenetics and monosomal karyotype associated with higher risk of relapse |
| Gene mutations | IPSS-M | IPSS-M high/very high risk (often including TP53 mutations) associated with poor outcome and high risk of relapse |
| Disease status after treatment interventions | ||
| ESA-lenalidomide failure | IWG criteria | No direct impact reported |
| HMAs-ICT failure | IWG criteria | HSCT is the best available treatment after HMAs-ICT failure, but response status is a prognostic factor |
| Prognostic risk factor . | Tools to measure risk factors in patients with MDS . | Impact on timing of HSCT . |
| Disease-related risk (without molecular information) | IPSS-R | Immediate transplantation is associated with maximal life expectancy in patients with early disease (IPSS-R ≤ 3.5), while for those with higher risk delayed transplantation offers optimal survival benefit. |
| Disease-related risk (including molecular information) | IPSS-M | Patients with higher risk according to IPSS-M should be considered for HSCT earlier than the conventional scoring system (IPSS-R) would dictate. |
| Prognostic risk factor . | Tools to measure risk factors in patients with MDS . | Outcome after HSCT in patients with MDS . |
|---|---|---|
| Patient-related features | ||
| Age | Calendar, age-adjusted IPSS-R | Worse outcome in elderly patients |
| Performance status | KS | KS >80% associated with better outcome |
| Comorbidities | HCT-CI | Low CI associated with better outcome |
| Disease-related features | ||
| % of marrow blasts | IPSS-R | <5% blasts associated with better outcome |
| Cytogenetics | IPSS-R | Poor-risk cytogenetics and monosomal karyotype associated with higher risk of relapse |
| Gene mutations | IPSS-M | IPSS-M high/very high risk (often including TP53 mutations) associated with poor outcome and high risk of relapse |
| Disease status after treatment interventions | ||
| ESA-lenalidomide failure | IWG criteria | No direct impact reported |
| HMAs-ICT failure | IWG criteria | HSCT is the best available treatment after HMAs-ICT failure, but response status is a prognostic factor |
| Prognostic risk factor . | Tools to measure risk factors in patients with MDS . | Impact on timing of HSCT . |
| Disease-related risk (without molecular information) | IPSS-R | Immediate transplantation is associated with maximal life expectancy in patients with early disease (IPSS-R ≤ 3.5), while for those with higher risk delayed transplantation offers optimal survival benefit. |
| Disease-related risk (including molecular information) | IPSS-M | Patients with higher risk according to IPSS-M should be considered for HSCT earlier than the conventional scoring system (IPSS-R) would dictate. |
ESA, erythropoiesis stimulating agent; HCT-CI, HSCT-specific comorbidity index; ICT, intensive chemotherapy; IPSS-M, Molecular International Prognostic Scoring System; IPSS-R, Revised International Prognostic Scoring System; IWG, International Working Group; KS, Karnofsky scale.