ISSN 1866-8836
Клеточная терапия и трансплантация

CM-01. Comparison of prognosis between patients with therapy-related myelodysplastic syndrome after hematological malignancies and myelodysplastic syndrome de novo: retrospective cohort study

Polina V. Kotselyabina, Vladislav V. Kovalik, Vladislav V. Markelov, Nikita N. Burlov, Kirill V. Lepik, Natalia B. Mikhailova, Olga B. Kalashnikova, Nikolay Y. Tsvetkov, Ksenia S. Yurovskaya, Tatiana L. Gindina, Ivan S. Moiseev, Alexander D. Kulagin, Elena V. Morozova

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia

Contact: Dr. Polina V. Kotselyabina, e-mail:

doi 10.18620/ctt-1866-8836-2022-11-3-1-132


Prognosis of patients with therapy-related myelodysplastic syndrome (t-MDS), developing after previous chemotherapy or radiotherapy therapy for primary hematological malignancies, is not well described. It is not clear if the prior history of hematological malignancy contributes to prognosis beyond the IPSS-R score. The aims of our research were to compare overall survival for patients with de novo MDS (d-MDS) and t-MDS after primary hematological malignancy and evaluate the role of allo-HSCT in prognosis with patients with t-MDS.

Patients and methods

A retrospective cohort single-center study included 94 patients, i.e., 23 cases of t-MDS with history of primary hematological malignancy, and 71 with d-MDS. OS was assessed with Kaplan-Meier curves, and differences between the groups were assessed using log-rank test. A multivariate Cox proportional hazard model was constructed to adjust for IPSSR-R prognostic group, age, and history of allo-HSCT.


All patients were included into the analysis, with the median follow-up of 10 and 37 months for t-MDS and d-MDS, respectively. OS rate was significantly lower for t-MDS compared to d-MDS (p=0.04, log-rank test), with a median OS of 14 and 48 months, respectively. The treatment histories of primary hematological malignancy were associated with poor prognosis for patients, being independent on the IPSS-R and age (HR=1.9 [1.02; 3.37], p=0.04). At the same time, inclusion of allo-HSCT into the regression model made this factor not significant, with HR=1.2 [0.62; 2.27] (p=0.6). Allo-HSCT was performed in 30% of patients (n=7) with t-MDS and 73% of patients (n=52) with d-MDS. The frequency of transformation into acute myeloid leukemia (AML) and the median terms of AML transformation did not differ significantly for t-MDS and d-MDS groups (p=0.06 and p=0.27, respectively). Unfavorable cytogenetic risk, according to Armand risk score, was established in 20% (n=14) for d-MDS group and 70% (n=16) in the t-MDS group (p<0.001). The main characteristics of patients with t-MDS (primary diagnosis, stage of disease, durations of cytopenia, previous therapy) were also subject to analysis. Median time from cytopenia to the t-MDS diagnosis was 1.5 months. The structure of primary malignancies included classical Hodgkin’s lymphoma 48% (n=11), non-Hodgkin’s lymphomas 34% (n=8), acute leukemia 9% (n=2), and chronic lymphocytic leukemia 9% (n=2). The primary cancer status at the time of t-MDS diagnosis showed complete remission in 78% (n=18). Therapy for previous malignant neoplasms included chemotherapy alone in 44% (n=10) as well as combined chemotherapy and radiation treatment in 56% of cases (n=13). The predictive value of risk stratification proposed by MD Anderson Cancer Center Group for t-MDS (TPSS) was demonstrated (p=0.01). Regarding the OS rate among the t-MDS group was significantly higher for the patients who underwent allo-HSCT (p=0.02, log-rank test).


History of treatment of primary hematological malignancy can be independently associated with poor prognosis for the patients with t-MDS, being independent on the IPSS-R and age. However, uneven distribution of allo-HSCT frequency among the groups may probably be a confounding factor which leads to differential prognosis between these groups, thus requiring further research.


Secondary myelodysplastic syndrome, therapy-related, allogeneic hematopoietic stem cell transplantation.

Volume 11, Number 3

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doi 10.18620/ctt-1866-8836-2022-11-3-1-132

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