TY - JOUR
T1 - Pretransplant Neutropenia Is Associated with Poor-Risk Cytogenetic Features and Increased Infection-Related Mortality in Patients with Myelodysplastic Syndromes
AU - Scott, Bart L.
AU - Park, J. Y.
AU - Deeg, H. Joachim
AU - Marr, Kieren A.
AU - Boeckh, Michael
AU - Chauncey, Thomas R.
AU - Appelbaum, Frederick R.
AU - Storb, Rainer
AU - Storer, Barry E.
N1 - Funding Information:
This work was supported in part by grants HL084054, HL36444, CA18029, CA15704, and HL82941 from the National Institutes of Health, Bethesda, MD. We thank the HSCT teams at the Fred Hutchinson Cancer Research Center and the Seattle VA Puget Sound Health Care System for their contributions, all patients for their participation in these trials, Joanne Greene and Franchesca Nguyen for maintaining the patient database, and Bonnie Larson and Helen Crawford for help with manuscript preparation.
PY - 2008/7
Y1 - 2008/7
N2 - A retrospective cohort analysis was performed to determine the impact of neutropenia on the outcome of hematopoietic cell transplantation (HSCT) in patients with myelodysplasia (MDS). Among 291 consecutive patients, 178 (61%) had absolute neutrophil counts (ANCs) <1500/μL and 113 (39%) had ANCs ≥1500/μL within 2 weeks before HSCT. Neutropenic patients more often had poor-risk karyotypes (34% versus 12%, P < .0001) and high-risk International Prognostic Scoring System scores (37% veresus 18%, P = .0006). After HSCT, the rate of infections caused by Gram-positive bacteria and invasive fungal infections was significantly increased among neutropenic patients (rate ratio [RR] 1.77, P = .02 and RR = 2.56, P = .03, respectively), whereas infections caused by Gram-negative bacteria were not affected (RR 1.33, P = .53). The hazards of nonrelapse mortality (NRM) (hazard ratio [HR] = 1.62 [1.1-2.4], P = .01), overall mortality (HR = 1.55 [1.1-2.1], P = 0.007), and infection-related mortality (HR = 2.22 [1.2-4.2], P = .01) were increased in neutropenic patients, whereas relapse, engraftment, and graft-versus-host-disease were not affected. After adjusting for cytogenetic risk and marrow myeloblast percentages, neutropenic patients remained at significant hazard for infection-related mortality (HR = 1.94 [1.0-3.8], P = .05), but not for overall mortality or NRM. We propose that intensified strategies to prevent infections should be implemented in MDS patients with preexisting neutropenia who undergo HSCT.
AB - A retrospective cohort analysis was performed to determine the impact of neutropenia on the outcome of hematopoietic cell transplantation (HSCT) in patients with myelodysplasia (MDS). Among 291 consecutive patients, 178 (61%) had absolute neutrophil counts (ANCs) <1500/μL and 113 (39%) had ANCs ≥1500/μL within 2 weeks before HSCT. Neutropenic patients more often had poor-risk karyotypes (34% versus 12%, P < .0001) and high-risk International Prognostic Scoring System scores (37% veresus 18%, P = .0006). After HSCT, the rate of infections caused by Gram-positive bacteria and invasive fungal infections was significantly increased among neutropenic patients (rate ratio [RR] 1.77, P = .02 and RR = 2.56, P = .03, respectively), whereas infections caused by Gram-negative bacteria were not affected (RR 1.33, P = .53). The hazards of nonrelapse mortality (NRM) (hazard ratio [HR] = 1.62 [1.1-2.4], P = .01), overall mortality (HR = 1.55 [1.1-2.1], P = 0.007), and infection-related mortality (HR = 2.22 [1.2-4.2], P = .01) were increased in neutropenic patients, whereas relapse, engraftment, and graft-versus-host-disease were not affected. After adjusting for cytogenetic risk and marrow myeloblast percentages, neutropenic patients remained at significant hazard for infection-related mortality (HR = 1.94 [1.0-3.8], P = .05), but not for overall mortality or NRM. We propose that intensified strategies to prevent infections should be implemented in MDS patients with preexisting neutropenia who undergo HSCT.
KW - MDS
KW - Neutropenia
KW - Stem cell transplant
UR - http://www.scopus.com/inward/record.url?scp=44649102568&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=44649102568&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2008.04.011
DO - 10.1016/j.bbmt.2008.04.011
M3 - Article
C2 - 18541200
AN - SCOPUS:44649102568
SN - 1083-8791
VL - 14
SP - 799
EP - 806
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 7
ER -