Table 1.
Prognostic risk factors relevant for HSCT eligibility and for outcome after HSCT
| Prognostic risk factor | Tools to measure risk factors in patients with MDS | Outcome after | ||
|---|---|---|---|---|
| Nontransplant interventions, including supportive care | HSCT | |||
| Patient related | ||||
| Age (chronological) | Calendar, IPSS-R20 | Age influences prognostic impact of disease-related factors20 | Impact age influenced by other patient-related factors15 | |
| Performance status (functional ability) | Karnofsky status ≥ 80% | Better survival after HSCT15 | ||
| Frailty (reduced physical fitness) | Specific tools have to be tested in HSCT117 | Fit patients better outcome12,16-18 | ||
| Comorbidities | HSCT-specific CI (HCT-CI)14 | Low CI better outcome13 | ||
| Disease related | ||||
| Percentage of marrow blasts | IPSS(-R), WPSS, WHO20,21 | Related to prognosis20,21 | Only impact if <5% marrow blasts22 | |
| Cytogenetic risk groups | IPSS(-R), WPSS, CPSS20,21,44 | 5 prognostic groups19 | Only very-poor-risk29 and monosomal karyotype30 | |
| Severity of cytopenias | IPSS(-R), WPSS41,42 | IPSS-R better prediction of prognosis compared with IPSS42 | Only very-poor-risk group of IPSS-R prognostic | |
| Marrow fibrosis | WHO criteria51 | Severity fibrosis prognostic51 | Severity fibrosis prognostic52 | |
| Transfusions burden | WPSS41,63 | WPSS41 | WPSS64 | |
| FCM | ELN FCM score25,27 | ELN FCM score24 | Not validated yet27 | |
| Molecular mutations | No specific tools yet34 | Mutations in RUNX1, U2AF1, ASXL1, TP53, and others: poor prognosis34 | Mutations in TP53, EZH2, ETV6 poor prognostic23,35 | |
| Disease status (after nontransplant treatment interventions) | ||||
| ESA failure | High Epo levels, high transfusion intensity6,68 | High Epo levels, high transfusion intensity6,68 | No direct impact reported | |
| Lenalidomide failure | Absence of 5q−5 | Absence of 5q−5 | No direct impact reported | |
| HMA failure | HMA-therapy–specific risk score71 | HMA-therapy–specific risk score,71 complex karyotype118 TET2 and TP53 mutations72,73 | Best available treatment after HMA failure,76 but response status prognostic factor | |
| ICT | MDS-specific risk score4 | MDS-specific risk score4 | Best available treatment available after failure of first-line ICT,70 but response status and remission duration prognostic factor31 | |