title: Positive impact of chronic graft-versus-host disease on the outcome of patients with de novo myelodysplastic syndrome after allogeneic hematopoietic cell transplantation: a single-center analysis of 115 patients.
abstract: To evaluate the impact of graft-versus-host disease (GVHD) and prognostic factors for patients with myelodysplastic syndrome (MDS) after allogeneic hematopoietic cell transplantation (allo-HCT), we retrospectively reviewed 115 patients with MDS or acute myeloid leukemia with multilineage dysplasia (AML-MLD) after allo-HCT at our center. Eighty one patients received reduced-intensity conditioning (RIC) regimens, whereas 34 received myeloablative conditioning regimens. Although the RIC group was significantly older and included more patients with poor cytogenetic risk, no difference in 4-yr overall survival (OS) was seen between the two groups. In a multivariate analysis, covariates associated with a worse OS were the French-American-British stage of refractory anemia excess blasts in transformation/AML-MLD at peak, poor cytogenetic risk, bone marrow blasts of 20% or higher at HCT and the absence of chronic GVHD (cGVHD). By using semi-landmark analyses, we found that the presence of cGVHD significantly improved OS in high-risk patients or the RIC group. However, there was no difference in OS between those with and without cGVHD among low-risk MDS patients. These findings suggest that the graft-versus-leukemia effect may be more beneficial in high-risk patients who do not receive intensive preparative regimens.
authors.affiliation: Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hiramoto
authors.forename: Saiko
authors.initials: S
authors.lastname: Kurosawa
authors.forename: Kinuko
authors.initials: K
authors.lastname: Tajima
authors.forename: Keiji
authors.initials: K
authors.lastname: Okinaka
authors.forename: Kohei
authors.initials: K
authors.lastname: Tada
authors.forename: Yujin
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Akihito
authors.initials: A
authors.lastname: Shinohara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Inoue
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Ueda
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanaka
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Heike
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D011292:Premedication; D012008:Recurrence; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: allogeneic hematopoietic cell transplantation; graft-versus-host disease; graft-versus-leukemia effect; myelodysplastic syndrome