학술논문
Sequential vs myeloablative vs reduced intensity conditioning for patients with myelodysplastic syndromes with an excess of blasts at time of allogeneic haematopoietic cell transplantation: a retrospective study by the chronic malignancies working party of the EBMT
Document Type
Original Paper
Author
Potter, V.; Gras, L.; Koster, L.; Kroger, N.; Sockel, K.; Ganser, A.; Finke, J.; Labussiere-Wallet, H.; Peffault de Latour, R.; Koc, Y.; Salmenniemi, U.; Smidstrup Friis, L.; Jindra, P.; Schroeder, T.; Tischer, J.; Arat, M.; Pascual Cascon, M.; de Wreede, L. C.; Hayden, P.; Raj, K.; Drozd-Sokolowska, J.; Scheid, C.; McLornan, D. P.; Robin, M.; Yakoub-Agha, I.
Source
Bone Marrow Transplantation: Official journal of the European Society for Blood and Marrow Transplantation. 59(2):224-231
Subject
Language
English
ISSN
0268-3369
1476-5365
1476-5365
Abstract
The optimal conditioning for patients with higher risk MDS receiving potentially curative allogeneic haematopoietic stem cell transplant(allo-HCT) remains to be defined. This is particularly the case for patients with excess of blasts at time of allo-HCT. Sequential (Seq) conditioning, whereby chemotherapy is followed rapidly by transplant conditioning, offers an opportunity to decrease disease burden, potentially improving outcomes allo-HCT outcomes. Herein we present the only analysis comparing Seq to myeloablative (MAC) and reduced intensity conditioning (RIC) specifically focussed on MDS patients with excess of blasts at allo-HCT. 303 patients were identified in the EBMT registry, receiving RIC (n = 158), Seq (n = 105), and MAC (n = 40). Median follow-up was 67.2 months and median age at allo-HCT was 59.5 years (IQR 53.5–65.6). For the entire cohort, 3 y overall survival (OS) was 50% (95% CI 45–56%) and relapse free survival (RFS) 45% (95% CI 40–51%). No significant differences in OS (log-rank p = 0.13) and RFS (log-rank p = 0.18) were observed between conditioning protocols. On multivariable analysis, lower performance status, worse IPSS-R cytogenetics, sibling donor (compared to 8/8 MUD) and ≥20% blasts at allo-HCT were associated with worse outcomes. In conclusion, the Seq protocol did little to influence the outcome in this high-risk group of patients, with outcomes mostly determined by baseline disease risk and patient characteristics such as performance status.