title: Survival benefits with transplantation in secondary AML evolving from myelodysplastic syndrome with hypomethylating treatment failure.
abstract: The prognosis for patients with myelodysplastic syndrome with hypomethylating treatment failure (MDS-HTF) has been known to be poor. However, the clinical outcomes and optimal treatment options for secondary AML evolving from MDS-HTF (sAML/MDS-HTF) are not well known. This retrospective analysis was conducted to evaluate the clinical outcomes and influences of treatment options on survival in 46 consecutive patients with sAML/MDS-HTF. The median OS rates were 1.4 months in the best supportive care group (n=15) and 9.4 months in the active treatment group (n=31). One-year OS rates were 13.3% and 36.8%, respectively (P=0.001). Active treatment (P<0.001), lower BM blast (<33%) at sAML (P=0.007), non-poor NCCN (National Cancer Comprehensive Network) cytogenetics (P=0.001) and good performance status (ECOG (Eastern Cooperative Oncology Group) 1) (P=0.024) were significant predictors affecting favorable OS in a multivariate analysis. Of the active treatment options, allo-SCT with prior chemotherapy (CTx) showed better OS compared with CTx only or SCT without CTx (P=0.019). Our analyses suggest that active treatment, particularly SCT following CTx, should be considered in patients with sAML/MDS-HTF if the patient is medically fit.
authors.affiliation: Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: S-H
authors.initials: SH
authors.lastname: Shin
authors.forename: S-A
authors.initials: SA
authors.lastname: Yahng
authors.forename: J-H
authors.initials: JH
authors.lastname: Yoon
authors.forename: S-E
authors.initials: SE
authors.lastname: Lee
authors.forename: B-S
authors.initials: BS
authors.lastname: Cho
authors.forename: K-S
authors.initials: KS
authors.lastname: Eom
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: C-K
authors.initials: CK
authors.lastname: Min
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kim
authors.forename: S-G
authors.initials: SG
authors.lastname: Cho
authors.forename: D-W
authors.initials: DW
authors.lastname: Kim
authors.forename: J-W
authors.initials: JW
authors.lastname: Lee
authors.forename: W-S
authors.initials: WS
authors.lastname: Min
authors.forename: C-W
authors.initials: CW
authors.lastname: Park
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic