Analysis of prognostic factors for allogeneic marrow transplantation following busulfan and cyclophosphamide in myelodysplastic syndrome and after leukemic transformation

Abstract

Summary:Prognostic factors in 42 patients aged 11 to 62 (median 46) years, with myelodysplastic syndrome (MDS) or after leukemic transformation, who underwent allogeneic marrow transplantation between 1984 and 1999 were analyzed. Thirty-six had advanced disease morphology; 19 had leukemic transformation. Twenty-nine received a preparative regimen of BuCy 2 and 13 busulfan 14 mg/kg, etoposide 50 mg/kg and cyclophosphamide 120 mg/kg. Severe hepatic veno-occlusive disease (VOD) occurred in three patients all of whom received anti-leukemic chemotherapy prior to transplantation. Fifteen patients (36%) died from early transplantrelated complications; nine patients relapsed. The estimated 4 year disease-free survival (DFS) was 35% (95% CI 26-44%). Older age was the most significant adverse prognostic factor. Patients with leukemic transformation who underwent early transplantation had significantly better DFS than those treated first with chemotherapy (P = 0.002). Delayed toxicity was rare in these patients; no late relapses occurred. Bone Marrow Transplantation (2000) 25, 1219-1222. Keywords: myelodysplastic syndrome; BuCy; allogeneic transplantation Allogeneic marrow transplantation is the only curative treatment for the myelodysplastic syndrome (MDS). 1-3 Sustained disease-free survival has been reported to be in excess of 50% in selected patients. 4,5 However, patients with advanced disease morphology, ie refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T), chronic myelomonocytic leukemia (CMML), and acute leukemia evolving from myelodysplasia, have experienced high relapse rates and poorer rates of disease-free survival (DFS) compared to patients with less advanced disease. [2][3][4]6 Attempts to intensify preparative regimens, such as the addition of busulfan to cyclophosphamide and total body irradiation (TBI), have resulted in lower relapse rates, but also an increase in nonrelapse mortality. 6 Regimens using busulfan without total body irradiation have yielded favorable results for patients with MDS. 5,7 The present study analyzed long-term results and prognostic factors in patients with MDS, most with advanced disease, who received busulfan-based preparative therapy.

Impact of disease burden at time of allogeneic stem cell transplantation in adults with acute myeloid leukemia and myelodysplastic syndromes

“…8,27,28 In the multivariate analysis for OS, age X45 years correlated with decreased survival. The risk of death increased by a factor of 1.57 (57%) per decade.…”

Impact of pretransplant comorbidities on alemtuzumab-based reduced-intensity conditioning allogeneic hematopoietic SCT for patients with high-risk myelodysplastic syndrome and AML

“…[7][8][9][10][11][12][13][14][15][16] Recent literature has indicated that performance status of transplant recipients, rather than recipient age per se, may be a better indicator of the ability of a patient to tolerate allo-HSCT. The Charlson comorbidity index, adapted for HSCT, has been shown to predict NRM in patients receiving allogeneic HSCT.…”

Peripheral blood is safer than bone marrow as a source of hematopoietic progenitors in patients with myelodysplastic syndromes who receive an allogeneic transplantation. Results from the Spanish registry

“…In previous reports, it has been shown that in the allogeneic transplantation setting for MDS patients, there is a high transplant-related mortality (TRM). [7][8][9][10][11][12] Other authors have observed that faster engraftment is achieved in hematological malignancies when PB is used as the cell source instead of BM. 14,15 Based on these findings, special attention was paid to differences between BM and PB as a source of HSCT in the present series.…”

“…5,6 Several risk factors predicting clinical evolution after allogeneic transplantation have been described such as disease stage, proportion of blast cells in BM, age, cytogenetic aberrations, disease duration and IPSS score. [7][8][9][10][11][12][13] The present report analyzes the outcome of 81 patients who have been reported to the Spanish registry for hematopoietic cell transplantation (Grupo Espan˜ol de Trasplante Hematopoye´tico, GETH), who underwent an allogeneic transplant from an HLA-identical sibling donor. In previous reports, it has been shown that in the allogeneic transplantation setting for MDS patients, there is a high transplant-related mortality (TRM).…”