Abstract
Effect of Pre- and Peri-Transplant Measurable Residual Disease Clearance in Patients with Myelodysplastic Neoplasm; A Referral Center Experience
Blood, Vol.144(Supplement 1), pp.7422-7422
11/05/2024
DOI: 10.1182/blood-2024-194001
Abstract
Introduction
Measurable residual disease (MRD) has emerged as a potential prognostic marker for allogeneic stem cell transplant (HSCT) outcomes in various hematologic malignancies. However, the MRD status in myelodysplastic neoplasm (MDS) or myelodysplastic/myeloproliferative neoplasm (MDS/MPN), can be difficult to interpret due to heterogenous disease biology and unique limitations in each MRD measuring techniques. In comparison to B-cell acute lymphoblastic leukemia whose clearance of pre-HSCT MRD is considered essential, the data in MDS or MDS/MPN is less clear. As post-HSCT disease surveillance becomes more standardized, we also evaluated the effect of peri-HSCT MRD status on relapse-free and overall survival (RFS and OS) outcomes.
Methods
We reviewed records of adult patients who underwent HSCT for MDS or MDS/MPN at our institution between 2012-2023 and report the outcomes of patients between those who had undetectable MRD (MRD-) vs detectable MRD (MRD+) pre-HSCT and conducted a conditional analysis of outcomes based on MRD status at day+90 post-HSCT.
Results
We identified 38 and 55 patients in MRD- and MRD+ cohorts respectively. Baseline patient characteristics were similar between the cohorts, including age, Revised and Molecular International Prognostic Scores (IPSS-R & IPSS-M), and HSCT-related factors. The MRD+ cohort had inferior RFS (HR: 1.84, 95% CI: 1.09-3.12, p=0.02) but a statistically significant difference in OS was not evidenced (HR: 1.52, 95% CI: 0.88-2.61, p=0.14). After adjusting for % blasts at diagnosis, and conditioning intensity, MRD+ patients were found to be at 1.92 times increased risk of relapse or death (95% CI: 1.12-3.28, p=0.02). Additionally, increasing IPSS-M score was associated with poorer RFS (HR: 1.27, 95% CI: 1.01-1.59, p=0.04) and OS (HR: 1.52, 95% CI: 1.20-1.91, p<0.01). On a conditional analysis of patients who were alive and in remission until day +90 post-HSCT, the pre-HSCT MRD status did not confer a statistically significant difference in RFS and OS if patients were able to achieve an MRD- status by day +90 post-HSCT.
Conclusion:
Pre- and peri-HSCT MRD testing may offer valuable survival prognostic information in patients with MDS and MDS/MPN and should be considered part of routine disease surveillance.
No relevant conflicts of interest to declare.
Details
- Title: Subtitle
- Effect of Pre- and Peri-Transplant Measurable Residual Disease Clearance in Patients with Myelodysplastic Neoplasm; A Referral Center Experience
- Creators
- Ratdanai Yodsuwan - University of IowaSarah L Mott - University of IowaAndrew Vegel - University of Iowa Hospitals and ClinicsAditya Ravindra - University of IowaPrajwal Dhakal - University of IowaGrerk Sutamtewagul - University of IowaMargarida Magalhaes-Silverman - University of Iowa, Hematology, Oncology, and Blood & Marrow TransplantationKittika Poonsombudlert - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Blood, Vol.144(Supplement 1), pp.7422-7422
- Publisher
- Elsevier Inc
- DOI
- 10.1182/blood-2024-194001
- ISSN
- 0006-4971
- Language
- English
- Date published
- 11/05/2024
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984757071802771
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