PF546 THE SFGM‐TC MDS SCORE AT DAY 180 IS ASSOCIATED WITH POST‐TRANSPLANT OUTCOMES IN PATIENTS WITH MYELODYSPLASTIC SYNDROME WHO UNDERWENT CD34+ SELECTED ALLOGENEIC STEM CELL TRANSPLANT
Authors: Alarcon A. , Devlin S. , Maloy M. , Ruiz J.D. , Escamilla M. Sanchez , Tamari R. , Shaffer B. , Castro‐Malaspina H. , Giralt S. , Perales M.A. 
Published: June 2019

Background:

In the past decade, advances in therapy and supportive care, along with a wider donor availability due to the haplotrasplant, the number of elderly patients who are able to undergo Allo‐HSCT with curative intent has been increased. One strategy that has been developed to reduce one of the most important transplant‐related morbidity and mortality variables (graft‐versus‐host disease, GVHD) is Ex vivo CD34+ selected T‐cell depletion (TCD). Despite all these advances, several questions remain unanswered in the pre‐HSCT, HSCT and remarkably in the post‐HSCT setting.

Because outcomes for patients with MDS are heterogeneous, individual risk stratification using tools is important in managing patients. Most published scoring systems have focused on prognostic variables measured before allo‐HSCT. While these scores are helpful for decision in terms of transplant, they fail to notice key transplant‐related variables.

Aims:

The aim of this study is to investigate the prognostic ability of a recently published scoring system (SFGM‐TC) in a cohort of patients with MDS who underwent TCD transplants.

Methods:

109 patients underwent a first TCD AlloHCT for MDS from 2007 to 2018. The SFGMTC score (Caulier et al. Curr Res Transl Med. 2018) is performed at day 100 and ranges from 0‐ 8, discriminating low (0), intermediate (1–3), and high risk (4–8). Additional analyses were performed at day 180 and day 365. A landmark analysis was done at each time point for the day 100, 180, and 365 analyses, respectively

Results:

Median age was 61 years (range 20 to 72 years), and 64 patients (59%) were male. 89 patients (82%) had a matched related or unrelated donor. All patients received myeloablative conditioning and ex vivo T cell depleted PBSC grafts (Table 1). With a median follow‐up of 57.5 months (3.5, 114.7) among survivors, 1 and 3‐year OS was 85.1% (95% CI, 76.8–90.6) and 66.9% (95% CI, 56.7–75.1), respectively. 70 patients (64.2%) were alive at last follow up. At post‐transplant day 180, 72 patients had a SFGM‐TC low risk and 29 patients an intermediate/high score. In contrast to the analysis at day 100, the SFGM‐TC score at day 180 was associated with outcomes. Using the day 180 score, OS was significantly worse in the intermediate/high risk group (p‐value 0.002, HR 3.25 [95%CI 1.60, 6.60]) (Figure 1) as compared to the low group. There was no significant difference in the SFGM‐TC score using a day 100 (p‐value 0.117, HR of Intermediate/high group: 1.89 [0.89, 4.01]) or day 365 landmark (p‐value 0.098, HR of Intermediate/high group: 2.01 [0.88, 4.59]).

Summary/Conclusion:

In patients with MDS undergoing TCD‐HCT, the SFGM‐TC score at day 180 is significantly associated with survival. The lower incidence of acute GVHD in recipients of CD34‐ selected transplants and the use of myeloablative condition regimens, with lower relapse, may explain the difference with the original finding that the SFGM‐TC was predictive at day 100 in unmodified grafts.

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