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

Abstract

Therapy-related myelodysplastic syndromes (t-MDSs, 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.

Long-term follow-up of therapy-related myelodysplasia and AML patients treated with allogeneic hematopoietic cell transplantation

“…With a median follow-up of 7.5 years, this is one of the longest reported follow-up studies for this specific patient clientele, revealing a 10 year OS and DFS rate of 24% (13-36%) and 24% (14-36%), respectively, whereas the NRM rate was 32% (22-46%). Regarding the 5 year time point, our data show a slightly higher OS and DFS rate, a lower NRM rate but a higher relapse rate, than previously reported by Litzow et al 6 Beyond others, this can be explained by the less toxic conditioning that was used in the majority of patients in our study. Although one of the limitations of the present study is the small patient number as compared with our colleagues, the inclusion of all patients irrespective of primary diagnosis until 2014, the predominance of RIC, the comparably high median age and the very long followup are novel and may reflect the current clinical practice more precisely.…”

“…6,7 Despite the small sample size, this was also the case in univariate and multivariate analyses in our cohort. Although it remains controversial whether allogeneic stem cell transplantation can alleviate the negative prognostic impact of adverse cytogenetics, it was recently demonstrated that leukemia stem cells, which are thought to account for relapse after therapy, highly express leukemiaassociated Ags and could be targeted by T cells.…”

“…6,7,[13][14][15][16] Here we present a retrospective long-term followup analysis of 79 unselected consecutive t-MDS/t-AML patients who underwent aHCT after predominantly RIC (73.4%) between 1995 and 2014. With a median follow-up of 7.5 years, this is one of the longest reported follow-up studies for this specific patient clientele, revealing a 10 year OS and DFS rate of 24% (13-36%) and 24% (14-36%), respectively, whereas the NRM rate was 32% (22-46%).…”

“…6,29 Thus, early non-related donor search should be conducted, if there is no matching related donor.…”

“…4,5 In recent years, it has become evident that the most successful curative treatment concept for t-MDS/t-AML patients resulting in substantial remission rates implements allogeneic hematopoietic cell transplantation (aHCT). Using a myeloablative conditioning regimen in 77% of patients in a cohort of 868 patients with a median age of 40 years, Litzow et al 6 reported an overall survival (OS) rate of 22% (95% confidence interval (CI), 19-26%) after 5 years, although the non-relapse mortality (NRM) and relapse rate at that time were 48% (95% CI, 44-51%) and 31% (95% CI, 28-34%), respectively. In another study from the European Group for Blood and Marrow Transplantation, Kröger et al 7 observed a 3 year OS of 35%, a NRM of 37% and a relapse rate of 31% in a comparable cohort of 461 t-MDS/t-AML patients with a median age of 40 years.…”