Allogeneic haematopoietic stem cell transplant in patients with lower risk myelodysplastic syndrome: a retrospective analysis on behalf of the Chronic Malignancy Working Party of the EBMT.
We report a retrospective analysis of 246 myelodysplastic syndrome (MDS) patients in the EBMT (The European Society for Blood and Marrow Transplantation) database who were transplanted for International Prognostic Scoring System (IPSS) low or intermediate-1 disease. The majority of these patients (76%) were reclassified as intermediate or higher risk according to R-IPSS. The 3-year overall survival (OS) and PFS were 58% and 54%, respectively. In a multivariate analysis, adverse risk factors for PFS were marrow blast percentage (hazard ratio (HR): 1.77, P=0.037), donor/recipient CMV serostatus (donor-/recipient+: HR: 2.02, P=0.011) and source of stem cells (marrow and non-CR: HR: 5.72, P<0.0001, marrow and CR: HR: 3.17, P=0.027). Independent risk factors for OS were disease status at time of transplant and the use of in vivo T-cell depletion (TCD). Patients who did not receive TCD and were transplanted from an unrelated donor had worse OS (HR: 4.08, P<0.0001). In conclusion, 'lower' risk MDS patients have better outcome than those with 'higher risk' after haematopoietic stem cell transplant (HSCT). Selecting the right source of stem cells, a CMV-positive donor for CMV-positive patients and using in vivo TCD results in the best outcome in these patients. More studies are needed to evaluate the role of HSCT in these patients as compared with conventional treatment.
Hôpital Saint-Louis, Service d'Hématologie-Greffe, Assistance Publique Hôpitaux de Paris, Paris, France.
M
M
Robin
Team METHODS, Epidemiology and Statistics Sorbonne Paris Cité Research Centre UMR 1153, Inserm, Paris Descartes University, Paris, France.|AP-HP, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, Paris, France.
R
R
Porcher
Medical University of Graz, Hematology Department, Graz, Austria.
W
W
Zinke-Cerwenka
EBMT Data Office, Leiden, The Netherlands.
A
A
van Biezen
Helsinki University Central Hospital, Hematology Department, Helsinki, Finland.
L
L
Volin
King's College Hospital, Hematology Department, London, UK.
G
G
Mufti
Queen Elizabeth Hospital, Hematology Department, Birmingham, UK.
C
C
Craddock
Universitatsklinikum, Hematology Department, Freiburg, Germany.
J
J
Finke
Hospital de Valdecilla, Hematology Department, Santander, Spain.
C
C
Richard
University Hospital, Hematology Department, Basel, Switzerland.
J
J
Passweg
Oxford University Hospital NHS Trust, Hematology Department, Oxford, UK.
A
A
Peniket
Uz Gasthuisberg, Hematology Department, Leuven, Belgium.
J
J
Maertens
Gazi University, Hematology Department, Ankara, Turkey.
G
G
Sucak
Rikshospitalet, Oslo, Norway.
T
T
Gedde-Dahl
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
A
A
Vitek
Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
A
A
Nagler
IPC, Hematology Department, Marseille, France.
D
D
Blaise
University Hospital, Hematology Department, Essen, Germany.
D
D
Beelen
CHU, Hematology Department, Poitiers, France.
N
N
Maillard
Center of Bone Marrow Transplantation, Wiesbaden, Germany.
R
R
Schwerdtfeger
University Medical Centre St Radboud, Hematology Department, Nijmegen, Netherlands.
T
T
de Witte
University Hospital, Hematology Department, Hamburg, Germany.
N
N
Kroger
D064591:Allografts; D000754:Anemia, Refractory, with Excess of Blasts / Q000401:mortality* / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate