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Blood. 2017 Mar 30;129(13):1753-1762. doi: 10.1182/blood-2016-06-724500. Epub 2017 Jan 17.

Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel.

Author information

1
Department of Tumor Immunology, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
2
St. James's Institute of Oncology, Leeds, United Kingdom.
3
Department of Hematology and Bone Marrow Transplantation, Hôpital Saint-Louis/Assistance Publique-Hôpitaux de Paris (AP-HP)/University Paris 7, Paris, France.
4
Policlinica San Matteo, University of Pavia, Pavia, Italy.
5
Division of Hematology, Oncology, and Hemostasiology, University of Leipzig, Leipzig, Germany.
6
Centre International de Recherche sur l'Inflammation de Lille, INSERM U995/Centre Hospitalier Universitaire/Université Lille 2, Lille, France.
7
Department of Haematological Medicine, School of Medicine, Guy's, King's College and St. Thomas's Hospitals, London, United Kingdom.
8
Service d'Hématologie Seniors, Hôpital Saint-Louis/AP-HP/University Paris 7, Paris, France.
9
Hospital Universitario La Fe, Valencia, Spain.
10
Division of Clinical Hematology, Hematology Department, Hospital de la Santa Creu i Sant Pau/Autonomous University of Barcelona, Barcelona, Spain.
11
Clinica Ematologica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.
12
Hematology and Bone Marrow Transplantation Center, Fondazione IRCCS Ospedale Maggiore Policlinico/University of Milan, Milan, Italy.
13
Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
14
Hematology Division, Basel University Hospital, Basel, Switzerland.
15
Medical Faculty, University Hospital Düsseldorf/Heinrich Heine University, Düsseldorf, Germany.
16
Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
17
Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
18
Department of Medicine, Hematology, and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
19
Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
20
Department of Hematology, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands.
21
Karolinska University Hospital, Huddinge, Sweden.
22
Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.
23
Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
24
Fred Hutchinson Cancer Research Center, Seattle, WA.
25
University of Washington, Seattle, WA.
26
Dana-Farber Cancer Institute, Boston, MA.
27
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI.
28
Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.
29
Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.
30
Moffitt Cancer Center, Tampa, FL; and.
31
Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.

PMID:
28096091
PMCID:
PMC5524528
DOI:
10.1182/blood-2016-06-724500
[Indexed for MEDLINE]
Free PMC Article

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