[The clinical analysis of allogeneic hematopoietic stem cell transplantation from human leukocyte antigen-identical siblings in 95 patients with myelodysplastic syndrome].
OBJECTIVE
To evaluate the efficacy and optimize the timing of allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leukocyte antigen (HLA)-identical siblings for myelodysplastic syndrome (MDS).


METHODS
From January 2003 to December 2012, 95 patients with MDS or secondary acute myeloid leukemia (AML) were treated with HLA-identical allo-HSCT in our hospital. The median age was 43 (21-59) years. Conditioning regimens including modified busulfan (Bu)/cyclophosphamide (Cy) or Bu/ fludarabine (Flu) were used. All patients received transfusion of donor stem cells mobilized by granulocyte colony-stimulating factor (G-CSF) from bone marrow and/or peripheral blood. Eleven patients had refractory anemia (RA) or RA with ringed sideroblasts, 53 of RA with excess blasts (RAEB), 15 of RAEB in transformation (RAEB-t), and 16 progressing to secondary AML.


RESULTS
A total of 93 patients achieved sustained myeloid engraftment. The cumulative incidence of grade II-IV acute graft versus host disease (aGVHD) was 12.9% ± 3.5%. The 3-year cumulative incidence of chronic graft versus host disease (cGVHD) was 80.3% ± 4.9%. After a median follow-up of 28.7 months, 29 patients died. The 3-year estimated overall survival (OS) and disease-free survival (DFS) rates were 69.9% ± 5.0% and 58.0% ± 5.4% respectively. The cumulative relapse rate (RR) was 25.9% ± 4.7%, while non-relapse mortality (NRM) was 16.1% ± 4.0%. Multivariate analyses showed that non II-IV aGVHD and cGVHD were favorable factors associated with OS. Low DFS rate was correlated with high scores of international prognostic scoring system (IPSS). Patients with RAEB-t and AML (n = 31) were divided into 3 groups: no chemotherapy before HSCT (Group 1), chemotherapy but not achieving remission (Group 2) and chemotherapy and achieving remission (Group 3). The 3-year OS rate was 100.0% in Group 3, which was significantly higher than those of Groups 1 and 2 with 33.9%, 32.7% respectively (P < 0.05). The difference of DFS and RR in the three groups did not reach statistic difference.


CONCLUSIONS
Allo-HSCT from HLA-identical siblings is effective for patients with MDS. IPSS is of prognostic value for post-transplantation outcome. For patients with progressive disease before transplantation, maximal control of blasts in bone marrow may improve the prognosis of advanced MDS.
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Ting
T
Zhao
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Xiaojun
X
Huang
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Daihong
D
Liu
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Jingzhi
J
Wang
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Xiaohui
X
Zhang
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Yu
Y
Wang
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Wei
W
Han
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Huan
H
Chen
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Yuhong
Y
Chen
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Fengrong
F
Wang
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China.
Kaiyan
K
Liu
Peking University Institute of Hematology, the People's Hospital, Peking University, Beijing 100044, China. Email: lpxu_0415@sina.com.
Lanping
L
Xu
D000293:Adolescent; D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D012189:Retrospective Studies; D035781:Siblings; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous; D055815:Young Adult
D006680:HLA Antigens