Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative option for myelodysplastic syndromes (MDSs) but is severely limited by nonrelapse mortality (NRM), especially in this mostly older population. Comorbidity assessment is crucial to predict NRM and often assessed with the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI). Moreover, the impact of age on NRM still remains a matter of debate. In recent years, the age at which transplants are made has been progressively increasing, and patients with comorbidities have become more common. Extricating the respective roles of age and comorbidities in toxic mortality is all the more important. This study by the European Group for Blood and Marrow Transplantation registry included 1245 adult patients who underwent a first allogeneic stem cell transplantation for MDSs between 2003 and 2014. Overall, 4-year NRM and overall survival were 32% and 47%, respectively. When considered as continuous predictors, HCT-CI score and age were associated with an increased hazard ratio (HR) for NRM. In multivariate analysis, age band (HR, 1.13; 95% CI, 1.02 to 1.25; P= .016), HCT-CI ≥3 (HR, 1.34; 95% CI, 1.04 to 1.73; P = .022), and Karnofsky Performance Status ≤80 (HR, 2.03; 95% CI, 1.52 to 2.73; P< .0001) were significantly predictive of a worse NRM. In our large cohort, both comorbidities, evaluated by the original HCT-CI score, and chronological age significantly affected NRM. Thus, age should be part of the transplant decision-making process and should be integrated in future scoring systems predicting outcomes of HSCT in MDSs.

Centre Léon Bérard Lyon France

Charles University Hospital Pilsen Czech Republic

CHU Grenoble Alpes Grenoble France

European Group for Blood and Marrow Transplantation Data Office Leiden The Netherlands

Florence Nightingale Sisli Hospital Istanbul Turkey

Hannover Medical School Hannover Germany

Hôpital de l'Hôtel Dieu Paris France

Hopital St Louis Paris France

Hospital Regional de Málaga Málaga Spain

Hospital Universitario Ramon y Cajal Madrid Spain

HUCH Comprehensive Cancer Center Helsinki Finland

Imperial College Healthcare NHS Trust London UK

Klinikum Grosshadern Munich Germany

Medical Park Hospitals Antalya Turkey

Radboud University Medical Centre Nijmegen Nijmegen The Netherlands

Rigshospitalet Copenhagen Denmark

Unité d'Allogreffe Maladies du sang Lille France

Universitaetsklinikum Dresden Dresden Germany

University Hospital Eppendorf Hamburg Germany

University Hospital Essen Germany

University of Freiburg Freiburg Germany

University of Tor Vergata Rome Italy

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