Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis · 2026
Transfusion dependency as an independent predictor of mortality in myelodysplastic syndromes: Interaction across IPSS-R risk strata in a retrospective cohort.
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AlMoshary May, Bakhsh Ebtisam, Qushmaq Nahid Abdulhamid, Alharbi Ahmad Ali, Alzarea Ekremah A, Abdalhabib Ezeldine K, ALSubhi Samah Awad, Alanazi Fehaid M, Alenazy Fawaz, Kuriri Fahd A, Algarni Abdulrahman
Аннотация
BACKGROUND: Transfusion dependency (TD) is a recognized adverse prognostic marker in myelodysplastic syndromes (MDS), yet its predictors and survival impact remain poorly characterized in Saudi Arabian patients.
AIM: To identify clinical and hematologic predictors of TD and evaluate its impact on overall survival in a cohort of Saudi MDS patients.
METHODS: This single-center retrospective cohort study included 180 adult MDS patients diagnosed per the WHO 2022 criteria. Multivariable logistic regression identified independent predictors of TD. Kaplan-Meier curves and Cox proportional hazards regression assessed survival outcomes. Mediation and interaction analyses explored TD's role within established risk frameworks.
RESULTS: Sixty percent of patients were transfusion dependent. Lower hemoglobin (OR = 0.40 per g/dL, p < .001) and poor cytogenetic risk (OR = 6.10, p = .002) were the strongest independent predictors of TD. Transfusion-dependent patients had significantly shorter median survival (38 vs. 51 months, p < .001). After multivariable adjustment, TD remained an independent predictor of mortality (HR = 2.67, p < .001). A significant interaction between TD and IPSS-R category was identified, while mediation analysis indicated TD operates as a parallel rather than mediating pathway.
CONCLUSION: TD is an independent, powerful predictor of mortality in MDS, driven primarily by severe anemia and poor cytogenetics. Dynamic monitoring of transfusion status is essential across all risk strata.
AIM: To identify clinical and hematologic predictors of TD and evaluate its impact on overall survival in a cohort of Saudi MDS patients.
METHODS: This single-center retrospective cohort study included 180 adult MDS patients diagnosed per the WHO 2022 criteria. Multivariable logistic regression identified independent predictors of TD. Kaplan-Meier curves and Cox proportional hazards regression assessed survival outcomes. Mediation and interaction analyses explored TD's role within established risk frameworks.
RESULTS: Sixty percent of patients were transfusion dependent. Lower hemoglobin (OR = 0.40 per g/dL, p < .001) and poor cytogenetic risk (OR = 6.10, p = .002) were the strongest independent predictors of TD. Transfusion-dependent patients had significantly shorter median survival (38 vs. 51 months, p < .001). After multivariable adjustment, TD remained an independent predictor of mortality (HR = 2.67, p < .001). A significant interaction between TD and IPSS-R category was identified, while mediation analysis indicated TD operates as a parallel rather than mediating pathway.
CONCLUSION: TD is an independent, powerful predictor of mortality in MDS, driven primarily by severe anemia and poor cytogenetics. Dynamic monitoring of transfusion status is essential across all risk strata.