Allogeneic hematopoietic stem-cell transplantation for patients 50 years or older with myelodysplastic syndromes or secondary acute myeloid leukemia.
OBJECTIVE
This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients.


METHODS
We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC).


RESULTS
The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P < .01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P < .01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P < .01) was the major independent variable associated with an inferior 4-year overall survival.


CONCLUSIONS
Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.
Lim
Ziyi
Z
Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom. ziyi.lim@kcl.ac.uk
Brand
Ronald
R
Martino
Rodrigo
R
van Biezen
Anja
A
Finke
Jürgen
J
Bacigalupo
Andrea
A
Beelen
Dietrich
D
Devergie
Agnes
A
Alessandrino
Emilio
E
Willemze
Roel
R
Ruutu
Tapani
T
Boogaerts
Marc
M
Falda
Michele
M
Jouet
Jean-Pierre
JP
Niederwieser
Dietger
D
Kroger
Nicolaus
N
Mufti
Ghulam J
GJ
De Witte
Theo M
TM
D000367:Age Factors; D000368:Aged; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D012189:Retrospective Studies; D014184:Transplantation, Homologous