The role of IPSS-m in predicting survival and relapse after allogeneic HSCT for MDS: A single center experience.

Abstract

e18577 Background: Next-generation sequencing (NGS) has revolutionized the diagnosis and management of Myelodysplastic Neoplasms (MDS), but the prognostic value of the Molecular International Prognostic Scoring System (IPSS-M) for survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. This study investigates the predictive power of IPSS-M in determining survival outcomes following allo-HSCT for MDS patients. Methods: We conducted a retrospective review of MDS patients who underwent their first allo-HSCT at our institution between 2018 and 2023, with available karyotypes and NGS data at diagnosis. IPSS-M risk scores were calculated, and patient characteristics and distribution are shown in Table 1. Kaplan-Meier curves were used to analyze progression-free survival (PFS) and overall survival (OS). Results: A total of 52 patients met the inclusion criteria, with a median age of 63.7 years; 75% were male. HSCT was performed after a median of 6.7 months from MDS diagnosis. Most patients (82.7%) underwent reduced-intensity conditioning, and 82.7% of HSCTs were from matched unrelated donors. After a median follow-up of 11.3 months (range 0.3 to 81 months), 1-year OS by IPSS-M risk categories were 66.7% (low), 33.3% (moderate-low), 80% (moderate-high), 45.5% (high), and 38.1% (very high). Additionally, t-MDS patients (n=10), regardless of their IPSS-M risk category, showed consistently poor outcomes, with a 1-year PFS of 38.1%. Conclusions: While survival varied across IPSS-M risk groups in our study, a consistent correlation with risk category was not observed, contributing to the ongoing debate regarding IPSS-M's prognostic value in MDS patients undergoing allo-HSCT. However, our findings underscore the consistently poor outcomes in t-MDS patients, regardless of their IPSS-M risk classification. These results highlight the need for further investigation into the prognostic significance of IPSS-M in this specific patient population. Due to the limited sample size of this study, larger cohorts are required to confirm these findings and provide more definitive conclusions. Baseline characteristics of the study population (N= 52 patients). Clinical Characteristics N (%) Sex  Male 39 (75%)  Female 13 (25%) Median age in years (range) 63.7 (28.5-73.9) IPSS- M  Very Low 0  Low 9 (17)  Moderate Low 6 (12)  Moderate High 5 (10)  High 11 (21)  Very High 21(40) Donor type  Related donor 9 (17.3)  Unrelated Donor 43 (82.7) Conditioning Regimen  Reduced Intensity 43 (82.7)  Myeloablative 9 (17.3)