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Haematologica. 2018 Feb;103(2):237-245. doi: 10.3324/haematol.2017.168716. Epub 2017 Nov 3.

Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation: a retrospective registry analysis on 698 patients by the Chronic Malignancies Working Party of the European Society of Blood and Marrow Transplantation.

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Department of Hematology and Oncology, Klinikum Augsburg, University of Munich, Augsburg, Germany
Department of Medical Statistics & Bioinformatics, Leiden University Medical Center, the Netherlands.
DKMS, German Bone Marrow Donor Center, Germany.
Department of Medicine 1, Hematology and Oncology, University of Freiburg, Germany.
Medizinische Klinik und Poliklinik I, Universitaets-Klinikum Dresden, Germany.
Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany.
Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland.
Division of Hematology, Oncology and Hemostaseology, University Hospital Leipzig, Germany.
Department of Bone Marrow Transplantation, University Hospital, Essen, Germany.
Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Medizinische Klinik II, Universität Tübingen, Germany.
KMT Zentrum, Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
Department of Hematology, University Hospital, Basel, Switzerland.
BMT Center Leiden, Leiden University Hospital, the Netherlands.
Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium.
Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.
Division of Stem Cell Transplantation and Immunotherapy, University Hospital Schleswig-Holstein Campus, Kiel, Germany.
CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France.
Hôpital Huriez, CHRU, Lille, France.
Department of Hematological Medicine, GKT School of Medicine, London, UK.
Institute of Hematology & Oncology, Hospital Clinic, Barcelona, Spain.
Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitätsmedizin Berlin, Germany.
Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Hematology - BMT, Hôspital St. Louis, Paris, France.
Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany.


No standard exists for the treatment of myelodysplastic syndrome relapsing after allogeneic stem cell transplantation. We performed a retrospective registry analysis of outcomes and risk factors in 698 patients, treated with different strategies. The median overall survival from relapse was 4.7 months (95% confidence interval: 4.1-5.3) and the 2-year survival rate was 17.7% (95% confidence interval: 14.8-21.2%). Shorter remission after transplantation (P<0.001), advanced disease (P=0.001), older age (P=0.007), unrelated donor (P=0.008) and acute graft-versus-host disease before relapse (P<0.001) adversely influenced survival. At 6 months from relapse, patients had received no cellular treatment, (i.e. palliative chemotherapy or best supportive care, n=375), donor lymphocyte infusion (n=213), or a second transplant (n=110). Treatment groups were analyzed separately because of imbalanced characteristics and difficulties in retrospectively evaluating the reason for individual treatments. Of the patients who did not receive any cellular therapy, 109 were alive at 6 months after relapse, achieving a median overall survival from this landmark of 8.9 months (95% confidence interval: 5.1-12.6). Their 2-year survival rate was 29.7%. Recipients of donor lymphocytes achieved a median survival from first infusion of 6.0 months (95% confidence interval: 3.7-8.3) with a 2-year survival rate of 27.6%. Longer remission after first transplantation (P<0.001) and younger age (P=0.009) predicted better outcome. Among recipients of a second transplant, the median survival from second transplantation was 4.2 months (95% confidence interval: 2.5-5.9), and their 2-year survival rate was 17.0%. Longer remission after first transplantation (P<0.001), complete remission at second transplant (P=0.008), no prior chronic graft-versus-host disease (P<0.001) and change to a new donor (P=0.04) predicted better outcome. The data enabled identification of patients benefiting from donor lymphocyte infusion and second transplantation, and may serve as a baseline for prospective trials.

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