title: A retrospective comparison of autologous and unrelated donor hematopoietic cell transplantation in myelodysplastic syndrome and secondary acute myeloid leukemia: a report on behalf of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).
abstract: Hematopoietic cell transplantation (HCT) is an effective treatment for myelodysplasia (MDS) and secondary acute myeloid leukemia (sAML). In this study, outcome of 593 patients with MDS/sAML after autologous and allogeneic HCT from a matched unrelated donor (MUD) were compared. A total of 167 (28%) patients received HCT from MUD without prior chemotherapy (MUD-U). The rest received HCT in first complete remission (CR1) (Autologous (Auto-CR1), n=290 (49%), HCT from MUD (MUD-CR1), n=136 (23%)). Survival at 3 years was best in MUD-CR1 (50%) compared to Auto-CR1 (41%) and MUD-U (40%) (P=0.01). Similarly, disease-free survival was 44% for MUD-CR1 compared to Auto-CR1 (28%) and MUD-U (34%) (P=0.03). Treatment-related mortality was 17% in Auto-CR1 compared to MUD-CR1 (38%) and MUD-U (49%) (P<0.001). Relapse for Auto-CR1 was 62% compared to 24 and 30% for MUD-CR1 and MUD-U, respectively (P<0.001). Outcome was best for patients with low tumor burden transplanted 6-12 months after diagnosis. Factors influencing outcome at 3 years were mainly significant in the first 6 months. Only, relapse after autologous HCT remained constant over time. Outcomes after allogeneic HCT in patients of 20-40 and >40 years were similar. Autologous and Allogeneic HCT from MUD offer the possibility of long-term survival to patients with MDS/sAML.
authors.affiliation: Department of Hematology/Oncology, University of Leipzig, Leipzig, Germany. alah@medizin.uni-leipzig.de
authors.forename: H K
authors.initials: HK
authors.lastname: Al-Ali
authors.forename: R
authors.initials: R
authors.lastname: Brand
authors.forename: A
authors.initials: A
authors.lastname: van Biezen
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.forename: M
authors.initials: M
authors.lastname: Boogaerts
authors.forename: A A
authors.initials: AA
authors.lastname: Fauser
authors.forename: M
authors.initials: M
authors.lastname: Egeler
authors.forename: J-Y
authors.initials: JY
authors.lastname: Cahn
authors.forename: R
authors.initials: R
authors.lastname: Arnold
authors.forename: H
authors.initials: H
authors.lastname: Biersack
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
authors.forename: T
authors.initials: T
authors.lastname: de Witte
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007951:Leukemia, Myeloid / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome