Characterizing Patients With MDS Who Undergo Allo-HSCT

Patients with myelodysplastic syndrome (MDS) who undergo allogeneic hematopoietic stem cell transplant (allo-HSCT) tend to experience higher in-hospital mortality and complications, according to research presented at the 2024 American Society of Hematology Annual Meeting & Exposition.¹

A retrospective study examined data from 4980 patients with MDS who underwent allo-HSCT and were recorded in the National Inpatient Database from 2016 to 2020. The authors found that patients with MDS who undergo allo-HSCT had a higher comorbidity burden compared with patients without MDS, and that patients with MDS were more likely to experience in-hospital mortality (adjusted OR, 1.33; 95% CI, 1.14-1.55; P = .0002). Patients with MDS also had more reported complications, including mechanical ventilation (aOR 1.30; 95% CI, 1.12-1.51; P = .0004), acute graft-vs-host disease (aOR, 1.26; 95% CI, 1.11-1.43; P = .0004) and neutropenic fever (aOR, 1.20; 95% CI, 1.12-1.28; P < .001).

More research is needed to determine which patients with MDS are the best candidates for allo-HSCT and how to reduce the risks associated with allo-HSCT patients with MDS. | Image credit: MdBabul - stock.adobe.com

On the other hand, patients with MDS exhibited a lower risk of Clostridium difficile infection (aOR, 0.75, 95% CI 0.66-0.86, P < .001), and no significant difference was observed when comparing venous thromboembolism/pulmonary embolism and acute kidney injury in the MDS group compared with the non-MDS group. Patients with MDS tended to be older (median age 62 years) vs those without MDS (median age 49 years), the study showed.

The authors noted that from 2016 to 2020, it became more common for patients with MDS to undergo allo-HSCT. These patients made up 13.2% of HSCT procedures in 2016, but the proportion grew to 17.3% by 2019. In 2020, perhaps due to the COVID-19 pandemic, the authors wrote, the number of patients with MDS undergoing allo-HSCT fell slightly to 16.4%.

“The increasing trend in HSCT utilization among MDS patients is promising and underscores the need for continued improvements in patient selection and peri-transplant care to enhance outcomes,” the authors wrote. “Further research is warranted to explore strategies to mitigate the risks associated with HSCT in this vulnerable population.”

Another study aimed to determine the barriers to allo-HSCT for patients with MDS, exploring the roles of age, race, and insurance.²

The study examined records of 30,460 patients who underwent HSCT in the National Inpatient Database Healthcare Cost and Utilization Project from 2016 to 2020. Of the total, 4980 had MDS. The non-MDS group had a median age of 49 years at the time of HSCT. Within the MDS cohort, 3900 patients were White, 210 were Black, 340 were Hispanic, and 385 identified as another race.

“While the median age of diagnosis of MDS is around 70 years, the median age of patients with MDS undergoing allogeneic HSCT was 62 years,” the authors wrote. “Despite studies showing similar outcomes in older patients with MDS undergoing allogeneic HSCT, it appears that age might still be a barrier to receiving allogeneic HSCT.”

White patients also faced a higher risk of in-hospital mortality compared with Hispanic patients in the study.

In terms of insurance status, patients with MDS were more likely to use Medicare to pay for HSCT compared with non-MDS recipients, and in-hospital mortality was higher in these patients. However, Medicare and private-pay patients faced reduced risk of acute kidney injury (AKI) and mechanical ventilation.

HSCT recipients with MDS were more likely to have comorbidities including chronic lung disease, diabetes mellitus, hypothyroidism, hypertension and obesity, compared with the non-MDS group.

Both studies concluded that patients with MDS undergoing allo-HSCT are older and have more comorbidities compared with non-MDS patients undergoing allo-HSCT.^1,2 Rao and colleagues also found that patients with MDS who undergo HSCT have a higher likelihood of dying in the hospital (aOR 1.33, 95% CI 1.14-1.55, P = .0002), are more likely to require mechanical ventilation (aOR 1.30, 95% CI 1.12-1.51, P = .0004) and suffer from neutropenic fever (aOR 1.20, 95% CI 1.12-1.28, P < .001).¹ Patients with MDS also experienced acute graft-vs-host disease at higher rates than non-MDS patients who underwent the transplant procedure (aOR 1.26, 95% CI 1.11-1.43, P = .0004).

However, patients with MDS exhibited a lower risk of Clostridium difficile infection (aOR 0.75, 95% CI 0.66-0.86, P< .001), and no significant difference was observed when comparing venous thromboembolism/pulmonary embolism and AKI in patients with MDS compared with the non-MDS group.

The authors noted that over 2016 to 2020, it became more common for patients with MDS to undergo HSCT, which they characterized as a “promising” development. Patients with MDS made up 13.2% of MSCT procedures in 2016, but the number grew to 17.3% by 2019. In 2020, perhaps due to the COVID-19 pandemic, the authors posited, the proportion of patients with MDS fell slightly to 16.4%.

More research is needed to determine which patients with MDS are the best candidates for HSCT and how best to reduce the significant risks for patients with MDS that undergo HSCT, Rao and colleagues stated. Despite the availability and knowledge of better supportive care options, guidance is still needed around how best to care for patients with MDS before and after the procedure, they wrote.

References

1. Rao AV, Sanjeevi A, Domench DIJ, Bhandari SK, Shah P. Outcomes and Trends of Allogenic Hematopoietic Stem Cell Transplant Among patients with MDS- NIS 2016-2020. Presented at: 66th ASH Annual Meeting & Exposition; December 7-10, 2024; San Diego, CA. Abstract 2431.

2. Sanjeevi A, Domench DIJ, Rao AV, Eltaher B, Sharif MH. Barriers to Allogenic Hematopoietic Stem Cell Transplantation in MDS: Exploring the Role of Age, Race and Insurance – an NIS Database Study from 2016-2020. Presented at: 66th ASH Annual Meeting & Exposition; December 7-10, 2024; San Diego, CA. Abstract 2296.