Allogeneic hematopoietic stem cell transplantation for primary myelodysplastic syndrome

Abstract

Characteristics and outcomes of 52 patients with myelodysplastic syndrome (MDS) who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were analyzed. Median age was 30 years (range 2-61 years) and median time from diagnosis to allo-HSCT was 10 months (range 1-161 months). Thirty-six patients had advanced MDS or acute myeloid leukemia following MDS at transplant. Conditioning with busulfan and cyclophosphamide was administered to 73% of patients, and the median value of graft dose was 2.595 x 10 8 of total nucleated cells/ kg. Overall survival and disease free survival at 4 years were 36% and 33%, respectively. Nineteen patients were alive, with a median follow-up of 3.8 years. Twelve patients relapsed and only one is alive, after donor lymphocyte infusion. Interval < 6 months between diagnosis and allo-HSCT decreased relapse (P = 0.01). Mortality and relapse were significantly lower among patients with less advanced disease (P = 0.03). Decreased mortality was also observed when transplant occurred after 1994, probably because more patients with less advanced disease received the procedure. Acute GVHD grades ≥ II occurred in 19 patients. Donor type (identical related versus non-related/partially matched related) influenced the incidence of acute GVHD (P = 0.03). Eleven patients developed chronic GVHD and previous acute GVHD was a risk factor (P = 0.03). Thirty-three patients died, 22 (67%) secondary to transplant-related complications. Patients with MDS should undergo allo-HSCT earlier, mainly if they have a compatible donor and are young. Rev. bras. hematol. hemoter. 2004;26(2):71-77.