Upfront allogeneic stem cell transplantation after reduced-intensity/nonmyeloablative conditioning for patients with myelodysplastic syndrome: a study by the Société Française de Greffe de Moelle et de Thérapie Cellulaire.
Cytoreduction before allogeneic stem cell transplantation (allo-SCT) for patients with myelodysplastic syndromes remains a debatable issue. After excluding patients who had received preconditioning induction chemotherapy, we analyzed 128 consecutive patients with myelodysplastic syndrome who received reduced-intensity or nonmyeloablative conditioning (RIC/NMA) allo-SCT. Among them, 40 received azacitidine (AZA) before transplant (AZA group) and 88 were transplanted up front (best supportive care [BSC] group). At diagnosis, 55 patients had intermediate 2 or high-risk scores per the International Prognostic Scoring System and 33 had a high cytogenetic risk score. Progression to a more advanced disease before allo-SCT was recorded in 22 patients. Source of stem cells were blood (n = 112) or marrow (n = 16) from sibling (n = 78) or HLA-matched unrelated (n = 50) donors. With a median follow-up of 60 months, 3-year overall survival, relapse-free survival, cumulative incidence of relapse, and nonrelapse mortality were, respectively, 53% versus 53% (P = .69), 37% versus 42% (P = .78), 35% versus 36% (P = .99), and 20% versus 23% (P = .74), for the AZA group and BSC group, respectively. Multivariate analysis confirmed the absence of statistical differences in outcome between the AZA and BSC groups, after adjusting for potential confounders using the propensity score approach. The absence of cytoreduction before RIC/NMA allo-SCT did not seem to alter the outcome. However, our results emphasize the need to perform prospective protocols to delineate the role of debulking strategy and to identify subsets of patients who may benefit from this approach.
Departement d'Hématologie, Centre Hospitalier Universitaire, Université de Caen, Faculté de Médecine, Caen, France.
Gandhi
G
Damaj
Departement d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Université Paris 6, Paris, France.
Mohammad
M
Mohty
Departement d'Hématologie-Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital St. Louis, Université Paris 7, Paris, France.
Marie
M
Robin
Departement d'Hématologie, Centre Hospitalier Universitaire Lyon Sud, Lyon, France.
Mauricette
M
Michallet
Departement d'Hématologie, Centre Hospitalier Universitaire, Nantes, France.
Patrice
P
Chevallier
Departement d'Hematologie, Centre Hospitalier Universitaire and University of Liège, Belgium.
Yves
Y
Beguin
Departement d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Université Paris 6, Paris, France.
Stephanie
S
Nguyen
Departement d'Hématologie, Hôpitaux Universitaires de Strasbourg, France.
Pierre
P
Bories
Departement d'Hématologie, Institut Paoli-Calmettes, Marseille, France.
Didier
D
Blaise
Departement d'Hématologie, Centre Hospitalier Universitaire, Poitiers, France.
Natacha
N
Maillard
Departement d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Université Paris 6, Paris, France.
Marie Therese
MT
Rubio
Departement d'Hématologie, Centre Hospitalier Universitaire, Montpellier, France.
Nathalie
N
Fegueux
Departement d'Hématologie, Centre Hospitalier Universitaire, Rennes, France.
Jerome
J
Cornillon
Departement d'Hématologie, Centre Hospitalier Universitaire, Angers, France.
Aline
A
Clavert
Departement d'Hématologie, Centre Hospitalier Universitaire Purpan, Toulouse, France.
Anne
A
Huynh
Departement d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Université Paris 13, Bobigny, France.
Lionel
L
Adès
Departement d'Hématologie, Centre Hospitalier Universitaire et Unité Mixte de Recherche 5525 Centre National de Recherche Scientifique-Université Joseph Fournier, Grenoble, France.
Anne
A
Thiébaut-Bertrand
Departement d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Université Paris 5, Paris, France.
Olivier
O
Hermine
Departement d'Hématologie, Centre Hospitalier Universitaire, Bordeaux, France.
Stephane
S
Vigouroux
Departement d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Université Paris 13, Bobigny, France.
Pierre
P
Fenaux
Departement de Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Centre Hospitalier Universitaire, Lille, France.
Alain
A
Duhamel
Departement d'Hématologie, Centre Hospitalier Régionale Universitaire, Lille, France. Electronic address: i-yakoub-agha@chru-lille.fr.
Ibrahim
I
Yakoub-Agha
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D055815:Young Adult
D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine
Azacitidine; Best supportive care; MDS; Transplantation