Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia

Mayo Clinic Rochester, Rochester, MN, USA.
Blood (Impact Factor: 10.45). 03/2010; 115(9):1850-7. DOI: 10.1182/blood-2009-10-249128
Source: PubMed


Therapy-related myelodysplastic syndromes (t-MDSs) and acute myeloid leukemia (t-AML) have a poor prognosis with conventional therapy. Encouraging results are reported after allogeneic transplantation. We analyzed outcomes in 868 persons with t-AML (n = 545) or t-MDS (n = 323) receiving allogeneic transplants from 1990 to 2004. A myeloablative regimen was used for conditioning in 77%. Treatment-related mortality (TRM) and relapse were 41% (95% confidence interval [CI], 38-44) and 27% (24-30) at 1 year and 48% (44-51) and 31% (28-34) at 5 years, respectively. Disease-free (DFS) and overall survival (OS) were 32% (95% CI, 29-36) and 37% (34-41) at 1 year and 21% (18-24) and 22% (19-26) at 5 years, respectively. In multivariate analysis, 4 risk factors had adverse impacts on DFS and OS: (1) age older than 35 years; (2) poor-risk cytogenetics; (3) t-AML not in remission or advanced t-MDS; and (4) donor other than an HLA-identical sibling or a partially or well-matched unrelated donor. Five-year survival for subjects with none, 1, 2, 3, or 4 of these risk factors was 50% (95% CI, 38-61), 26% (20-31), 21% (16-26), 10% (5-15), and 4% (0-16), respectively (P < .001). These data permit a more precise prediction of outcome and identify subjects most likely to benefit from allogeneic transplantation.

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    • "Thus, allogeneic RIC-HSCT is a potential curative treatment option. t-MDS patients who have received more than two chemotherapeutic regimens or have undergone allograft more than 6 months after the diagnosis showed a significantly higher nonrelapse mortality [3, 4]. Thus, an earlier decision for the choice of therapies with allogeneic HSCT is necessary, once the diagnosis of t-MDS is made. "
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