title: Management of Myelodysplastic Syndrome Relapsing after Allogeneic Hematopoietic Stem Cell Transplantation: A Study by the French Society of Bone Marrow Transplantation and Cell Therapies.
abstract: To find out prognostic factors and to investigate different therapeutic approaches, we report on 147 consecutive patients who relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelodysplastic syndrome (MDS). Sixty-two patients underwent immunotherapy (IT group, second allo-HSCT or donor lymphocyte infusion), 39 received cytoreductive treatment alone (CRT group) and 46 were managed with palliative/supportive cares (PSC group). Two-year rates of overall survival (OS) were 32%, 6%, and 2% in the IT, CRT, and PSC groups, respectively (P < .001). In multivariate analysis, 4 factors adversely influenced 2-year rates of OS: history of acute graft-versus-host disease (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.26 to 2.67; P = .002), relapse within 6 months (HR, 2.69; 95% CI, .82 to 3.98; P < .001), progression to acute myeloid leukemia (HR, 2.59; 95% CI, 1.75 to 3.83; P < .001), and platelet count < 50 G/L at relapse (HR, 1.68; 95% CI, 1.15 to 2.44; P = .007). A prognostic score based on those factors discriminated 2 risk groups with median OSs of 13.2 versus 2.4 months, respectively (P < .001). When propensity score, prognostic score, and treatment strategy were included in Cox model, immunotherapy was found to be an independent factor that favorably impacts OS (HR, .40; 95% CI, .26 to .63; P < .001). In conclusion, immunotherapy should be considered when possible for MDS patients relapsing after allo-HSCT.
authors.affiliation: CHU de Clermont-Ferrand, Hôpital Estaing, Service d'Hématologie Clinique Adulte, and Université Clermont 1, Clermont-Ferrand, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guièze
authors.affiliation: CHU et Université Basse Normandie, Service d'Hématologie, Caen, France.
authors.forename: Gandhi
authors.initials: G
authors.lastname: Damaj
authors.affiliation: Biostatistics Unit, Direction de la Recherche Clinique, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Hématologie Greffe de moelle, AP-HP, Hôpital Saint-Louis, Université Paris 7, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Service d'Hématologie, CHU, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Service d'Hématologie Clinique, CHU, Lyon, France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Service d'Hématologie Clinique et Thérapie Cellulaire, CHU, Bordeaux, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Vigouroux
authors.affiliation: Hematology, CHU and University of Liège, Liège, Belgium.
authors.forename: Yves
authors.initials: Y
authors.lastname: Beguin
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: El Cheikh
authors.affiliation: Hématologie, Hôpital Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Roos-Weil
authors.affiliation: Hématologie, CHU et UMR 5525 CNRS-UJF, Grenoble, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Thiebaut
authors.affiliation: Service d'Hématologie, CHU, Nice, France.
authors.forename: Pierre-Simon
authors.initials: PS
authors.lastname: Rohrlich
authors.affiliation: Service d'Hématologie, CHU, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.affiliation: Service d'Hématologie, Institut de Cancérologie de la Loire, Saint-Etienne, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.affiliation: Service d'Hématologie, Centre Henri Becquerel, Rouen, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Contentin
authors.affiliation: Service d'Hématologie, APHP, Hôpital Necker Enfants-Malades, Université Paris 5, Paris, France.
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.affiliation: Service d'Hématologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.affiliation: Service d'Hématologie, AP-HP, Hôpital Saint-Antoine, Université Paris 6, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Service d'Hématologie, CHU, Poitiers, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.affiliation: Service d'Hématologie, CHU, Nancy, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Clement
authors.affiliation: Service des Maladies du Sang, CHU, Angers, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: François
authors.affiliation: Service d'Hématologie, CHU, Brest, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Guillerm
authors.affiliation: Hématologie, CHRU de lille, Inserm U995, and Université Lille 2, Lille, France. Electronic address: ibrahim.yakoubagha@live.fr.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D064987:Cell- and Tissue-Based Therapy / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D055815:Young Adult
keywords: Allogeneic hematopoietic stem cell transplantation; Donor lymphocyte infusion; Myelodysplastic syndrome; Prognosis; Relapse