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Bone Marrow Transplant. 2017 Feb;52(2):209-215. doi: 10.1038/bmt.2016.266. Epub 2016 Nov 7.

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.

Author information

1
Hôpital Saint-Louis, Service d'Hématologie-Greffe, Assistance Publique Hôpitaux de Paris, Paris, France.
2
Team METHODS, Epidemiology and Statistics Sorbonne Paris Cité Research Centre UMR 1153, Inserm, Paris Descartes University, Paris, France.
3
AP-HP, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, Paris, France.
4
Medical University of Graz, Hematology Department, Graz, Austria.
5
EBMT Data Office, Leiden, The Netherlands.
6
Helsinki University Central Hospital, Hematology Department, Helsinki, Finland.
7
King's College Hospital, Hematology Department, London, UK.
8
Queen Elizabeth Hospital, Hematology Department, Birmingham, UK.
9
Universitatsklinikum, Hematology Department, Freiburg, Germany.
10
Hospital de Valdecilla, Hematology Department, Santander, Spain.
11
University Hospital, Hematology Department, Basel, Switzerland.
12
Oxford University Hospital NHS Trust, Hematology Department, Oxford, UK.
13
Uz Gasthuisberg, Hematology Department, Leuven, Belgium.
14
Gazi University, Hematology Department, Ankara, Turkey.
15
Rikshospitalet, Oslo, Norway.
16
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
17
Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
18
IPC, Hematology Department, Marseille, France.
19
University Hospital, Hematology Department, Essen, Germany.
20
CHU, Hematology Department, Poitiers, France.
21
Center of Bone Marrow Transplantation, Wiesbaden, Germany.
22
University Medical Centre St Radboud, Hematology Department, Nijmegen, Netherlands.
23
University Hospital, Hematology Department, Hamburg, Germany.

Abstract

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.

PMID:
27819688
DOI:
10.1038/bmt.2016.266
[Indexed for MEDLINE]

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