title: HLA-matched allogeneic stem cell transplantation improves outcome of higher risk myelodysplastic syndrome A prospective study on behalf of SFGM-TC and GFM.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only a curative treatment in patients with higher risk myelodysplastic syndrome (MDS), although demethylating agents (DMA) have been reported to improve survival. The advantage of HSCT over other treatment comes from retrospective studies and the aim of the current study was to prospectively test this hypothesis, analyzing in particular patients from the pre-transplant period to avoid the selection bias of performing transplantation. This study was conducted to compare overall survival in MDS patients candidates to transplantation according to donor availability. The majority of patients (76%) received a treatment with DMA after registration, 69% had a human leukocyte antigen (HLA)-identical donor, 70% of whom were transplanted. Baseline patient and disease characteristics were similar according to donor availability. Four-year overall survival was significantly better in patients with an HLA matched donor (37%) compared to patients without donor (15%). There was also evidence that this overall survival advantage was because of transplantation. Mortality risk was decreased after transplantation but it became significant only after the second year post transplant, because of early transplant-related mortality. Our results appear to justify, in higher risk MDS, a transplantation approach in all potential candidates who have an HLA identical donor.
authors: 1] Hematologie - Transplantation; Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis, Paris, France [2] University Paris VII, Denis Diderot, Paris, France [3] Inserm U 1160, Paris, France.
authors: M
authors: M
authors: Robin
authors: 1] Team METHODS, Epidemiology and Statistics Sorbonne Paris Cité Research Centre UMR 1153, Inserm, Paris Descartes University, Paris, France [2] AP-HP, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, Paris, France.
authors: R
authors: R
authors: Porcher
authors: Hématologie sénior, Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis and Hôpital Avicenne, Paris, France.
authors: L
authors: L
authors: Adès
authors: Hématologie adulte, Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis, Paris, France.
authors: E
authors: E
authors: Raffoux
authors: Hématologie, CHU, Lyon, France.
authors: M
authors: M
authors: Michallet
authors: Hématologie, CHU, Angers, France.
authors: S
authors: S
authors: François
authors: Hématologie, CHU,UMR 5525 CNRS-UJF, Grenoble, France.
authors: J-Y
authors: JY
authors: Cahn
authors: Hématologie, CHU, Reims, France.
authors: A
authors: A
authors: Delmer
authors: Hématologie, CHU, Lyon, France.
authors: E
authors: 0000000342541692
authors: E
authors: Wattel
authors: Hématologie, CHU, Bordeaux, France.
authors: S
authors: S
authors: Vigouroux
authors: Hématologie, CHU, Clermont-Ferrand, France.
authors: J-O
authors: JO
authors: Bay
authors: Hématologie, Institut de Cancérologie de la Loire, Saint-Etienne, France.
authors: J
authors: J
authors: Cornillon
authors: Hématologie, CHU, Toulouse, France.
authors: A
authors: A
authors: Huynh
authors: Hématologie, hôpital de La Pitié Salpétrière Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis, Paris, France.
authors: S
authors: S
authors: Nguyen
authors: Hématologie, hôpital Saint-Antoine, Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis, Paris, France.
authors: M-T
authors: MT
authors: Rubio
authors: Hématologie, CHU, Montpellier, France.
authors: L
authors: L
authors: Vincent
authors: Hématologie, CHU, Poitiers, France.
authors: N
authors: N
authors: Maillard
authors: Hématologie CHU, Amiens, France.
authors: A
authors: A
authors: Charbonnier
authors: 1] Hematologie - Transplantation; Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis, Paris, France [2] University Paris VII, Denis Diderot, Paris, France [3] Inserm U 1160, Paris, France.
authors: R P
authors: RP
authors: de Latour
authors: Hématologie CHU, Caen, France.
authors: O
authors: O
authors: Reman
authors: 1] University Paris VII, Denis Diderot, Paris, France [2] Hématologie sénior, Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis and Hôpital Avicenne, Paris, France.
authors: H
authors: H
authors: Dombret
authors: 1] University Paris VII, Denis Diderot, Paris, France [2] Hématologie sénior, Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis and Hôpital Avicenne, Paris, France.
authors: P
authors: P
authors: Fenaux
authors: 1] Hematologie - Transplantation; Assistance Publique Hôpitaux de paris (AP-HP), Hôpital Saint Louis, Paris, France [2] University Paris VII, Denis Diderot, Paris, France [3] Inserm U 1160, Paris, France.
authors: G
authors: G
authors: Socié
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens