Erschienen in:
16.07.2019 | Original Article
Chronic graft-versus-host disease could ameliorate the impact of adverse somatic mutations in patients with myelodysplastic syndromes and hematopoietic stem cell transplantation
verfasst von:
Juan Carlos Caballero, Mercedes Sánchez Barba, Jesús María Hernández Sánchez, Esperanza Such, Kamila Janusz, Guillermo Sanz, Mónica Cabrero, Carmen Chillón, José Cervera, Ana María Hurtado, Andrés Jerez, Cristina Calderón Cabrera, David Valcárcel, Eva Lumbreras, María Abáigar, Félix López Cadenas, Jesús María Hernández Rivas, María Consuelo del Cañizo, María Díez Campelo
Erschienen in:
Annals of Hematology
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Ausgabe 9/2019
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Abstract
Somatic mutations in patients with myelodysplastic syndromes (MDS) undergoing allogeneic hematopoietic stem cell transplantation (HSTC) are associated with adverse outcome, but the role of chronic graft-versus-host disease (cGVHD) in this subset of patients remains unknown. We analyzed bone marrow samples from 115 patients with MDS collected prior to HSCT using next-generation sequencing. Seventy-one patients (61%) had at least one mutated gene. We found that patients with a higher number of mutated genes (more than 2) had a worse outcome (2 years overall survival [OS] 54.8% vs. 31.1%, p = 0.035). The only two significant variables in the multivariate analysis for OS were TET2 mutations (p = 0.046) and the development of cGVHD, considered as a time-dependent variable (p < 0.001), correlated with a worse and a better outcome, respectively. TP53 mutations also demonstrated impact on the cumulative incidence of relapse (CIR) (1 year CIR 47.1% vs. 9.8%, p = 0.006) and were related with complex karyotype (p = 0.003). cGVHD improved the outcome even among patients with more than 2 mutated genes (1-year OS 88.9% at 1 year vs. 31.3%, p = 0.02) and patients with TP53 mutations (1-year CIR 20% vs. 42.9%, p = 0.553). These results confirm that cGVHD could ameliorate the adverse impact of somatic mutations in patients with MDS with HSCT.