Allogeneic transplant outcomes in patients with myelodysplastic neoplasms

Title : Allogeneic transplant outcomes in patients with myelodysplastic neoplasms

Abstract:

Myelodysplastic Syndrome (MDS) represents a heterogeneous group of clonal hematopoietic disorders. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potentially curative therapy, yet factors influencing post-transplant outcomes remain insufficiently understood.Objective:To assess the impact of cytogenetic profile and blast percentage at diagnosis and before allo-HSCT on post-transplant outcomes in MDS patients. Methods:A retrospective study included 151 MDS patients treated at the R.M. Gorbacheva Memorial Institute (2008–2024). Subtypes were classified per WHO 2022, and risk stratified by IPSS-R. Cytogenetic profile (CG) and blast percentage were evaluated at diagnosis and before allo-HSCT (n=114). Pre-transplant therapy included hypomethylating agents (HMA), low-dose cytarabine (LDAC), polychemotherapy (PCT), and immunomodulatory agents (IA). Treatment response followed IWG 2006 criteria. Survival was analyzed using Kaplan–Meier and Fine–Gray methods.Results:The cohort included 81 males and 70 females (median age 48 years). Subtypes: MDS-EB-1 (38%), MDS-EB-2 (45%), lower-risk (17%). IPSS-R: low/intermediate (36%), high/very high (64%). Cytogenetic risk: favorable (50%), intermediate (15%), poor (25%), very poor (10%).Allo-HSCT was performed in 128 patients; median time from diagnosis to transplant was 11 months. Before transplantation, 73% had <10% blasts and 23% showed cytogenetic evolution. Donor types: matched related (30%), matched unrelated (47%), mismatched (16%), haploidentical (7%). Post-transplant cyclophosphamide was used in 78%.Two-year overall survival (OS2) was 49.5%; relapse incidence 33%, non-relapse mortality 24%. OS2 was higher in patients with <10% blasts before allo-HSCT (57% vs. 29%; p=0.004). Cytogenetic evolution was associated with inferior OS2 (23% vs. 61%; p=0.0004) and remained an independent adverse factor (HR=3.47; 95% CI: 1.7–6.9; p<0.001).Conclusion:Cytogenetic evolution before allo-HSCT independently predicts poorer survival in MDS. Early transplantation and improved risk-based timing may enhance post-transplant outcomes

Biography:

Krivitskaya Mariia Valeryevna is a final-year PhD student and researcher specializing in Myelodysplastic Syndromes with a focus on improving outcomes after allogeneic hematopoietic stem cell transplantation. Her previous work examined how disease status at transplantation influences survival and relapse, identifying key prognostic factors. Currently, she is studying disease evolution and cytogenetic changes to define high-risk MDS groups who may benefit from early preventive relapse strategies. She conduct her research at the R.M. Gorbacheva Memorial Research Institute, gaining experience in clinical data analysis and transplant modeling to support individualized, evidence-based care for patients with high-risk MDS.