Acquired
chromosomal abnormalities are important prognostic factors in patients with
myelodysplastic syndromes treated with supportive care and with disease-modifying therapeutic interventions, including allogeneic
hematopoietic stem cell transplantation. To assess the prognostic impact of cytogenetic characteristics after
hematopoietic stem cell transplantation accurately, we investigated a homogeneous group of 523 patients with primary
myelodysplastic syndromes who have received stem cells from
human leukocyte antigen-identical siblings. Overall survival at five years from
transplantation in good, intermediate, and poor cytogenetic risk groups according to the International Prognostic Scoring System was 48%, 45% and 30%, respectively (P<0.01). Both the disease status (complete remission vs. not
in complete remission) and the morphological classification at transplant in the untreated patients were significantly associated with probability of overall survival and relapse-free survival (P<0.01). The cytogenetic risk groups have no prognostic impact in untreated patients with
refractory anemia ± ringed sideroblasts (P=0.90). However, combining the good and intermediate cytogenetic risk groups and comparing them to the poor-risk group showed within the other three disease-status-at-transplant groups a hazard ratio of 1.86 (95%CI: 1.41-2.45). In conclusion, this study shows that, in a large series of patients with primary
myelodysplastic syndromes, poor-risk cytogenetics as defined by the standard International Prognostic Scoring System is associated with a relatively poor survival after allogeneic
stem cell transplantation from
human leukocyte antigen-identical siblings except in patients who are transplanted in
refractory anemia/
refractory anemia with ringed sideroblasts stage before progression to higher
myelodysplastic syndrome stages.