title: Allogeneic stem cell transplant for adults with myelodysplastic syndromes: relevance of pre-transplant disease status.
abstract: The aim of the present study was to investigate the outcome of 94 adult patients with myelodysplasia (MDS) who received an allogeneic stem cell transplant between January 1995 and September 2010 in two Italian hematology centers. At the time of transplant, 53 patients (56%) had relapsed/refractory disease. The cumulative incidence of grades II-IV acute graft-versus-host disease (GVHD) and chronic GVHD was 33% (95% confidence interval [CI] 21-45%) and 78% (95% CI 66-90%), respectively. The cumulative incidence of transplant-related mortality (TRM) at 100 days was 13% (95% CI 6-21%). The 2-year progression free survival (PFS) and overall survival (OS) were 41% (95% CI 31-51%) and 49% (95% CI 38-59%), respectively. On multivariate analysis, advanced disease stage at transplant was the major independent variable associated with an inferior 2-year PFS (HR 3.66, 95% CI 1.98-6.76) and OS (HR 3.68, 95% CI 1.95-6.93). Use of an alternative donor was an independent variable associated with TRM (HR 3.18, 95% CI 1.31-7.72). In conclusion, our data suggest that disease status at the time of transplant is the major predictor for improved PFS and OS, and treatments required to reach this goal may have value in leading to an improved outcome.
authors.affiliation: Bone Marrow Transplant Center.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Clara
authors.initials: C
authors.lastname: Pecoraro
authors.forename: Luisa
authors.initials: L
authors.lastname: Giaccone
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.forename: Bernardino
authors.initials: B
authors.lastname: Allione
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Corsetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Pini
authors.forename: Filippo
authors.initials: F
authors.lastname: Marmont
authors.forename: Ernesta
authors.initials: E
authors.lastname: Audisio
authors.forename: Stefano
authors.initials: S
authors.lastname: D'Ardia
authors.forename: Chiara
authors.initials: C
authors.lastname: Frairia
authors.forename: Anna
authors.initials: A
authors.lastname: Castiglione
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Michele
authors.initials: M
authors.lastname: Falda
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome