The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Myelodysplastic Syndromes: An Evidence-Based Review

Oliansky, Denise M; Antin, Joseph H.; Bennett, John M.; Deeg, H. Joachim; Engelhardt, Christin; Heptinstall, Kathleen; Lima, Marcos J.G. de; Gore, Steven D.; Potts, Ronald G.; Silverman, Lewis R.; Jones, Roy B.; McCarthy, Philip L.; Hahn, Theresa

doi:10.1016/j.bbmt.2008.12.003

Cited by 72 publications

(49 citation statements)

References 97 publications

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“…The clonal karyotype is the most powerful predictor of RFS after HCT for MDS (Alessandrino et al 2008;Oliansky et al 2009) (Fig. 1).…”

Section: Cytogeneticsmentioning

confidence: 99%

“…In an attempt to improve chances for post-HCT success, patients with a high marrow myeloblast count, say more than 5 or 10%, typically will receive pre-HCT therapy with a hypomethylating agent or with more classical induction type chemotherapy (de Lima et al 2004b;Kindwall-Keller and Isola 2009;Maris et al 2004;Nakai et al 2005;Oliansky et al 2009;Scott et al 2005;Warlick et al 2009;Yakoub-Agha et al 2000). While no data from controlled prospective trials are available, the clinical impression is Fig.…”

Section: Pretransplant Therapymentioning

confidence: 99%

“…However, there is no one-size-fits-all conditioning regimen (Oliansky et al 2009). Instead, conditioning should be tailored to diagnosis, disease stage, patient age, prior therapy, comorbidities and the other parameters of HCT, such as donor and stem cell source Ramakrishnan and Deeg 2008;Scott and Deeg 2006).…”

Section: Conditioning Regimensmentioning

confidence: 99%

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Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Deeg

Bartenstein

2011

Arch. Immunol. Ther. Exp.

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Hematopoietic cell transplantation (HCT) offers potentially curative therapy for patients with myelodysplastic syndrome (MDS). However, as the majority of patients with MDS is in the 7th or 8th decade of life, only few of these patients were transplanted following high-dose conditioning regimens. The development of reduced-intensity conditioning has allowed to apply HCT also to older patients and those with clinically relevant comorbid conditions. Dependent upon disease status and the type of clonal chromosomal abnormalities present at the time of HCT, some 25-75% of patients will be cured of their disease and survive long term. Recent results with HLA-matched unrelated donors are comparable to those with HLA genotypically identical siblings. The increasing use of cord blood and HLA-haploidentical donors is expected to make HCT available to a growing number of patients. However, post-transplant relapse and graft-versus-host disease remain problems requiring further instigations.

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“…The clonal karyotype is the most powerful predictor of RFS after HCT for MDS (Alessandrino et al 2008;Oliansky et al 2009) (Fig. 1).…”

Section: Cytogeneticsmentioning

confidence: 99%

Section: Pretransplant Therapymentioning

confidence: 99%

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Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Deeg

Bartenstein

2011

Arch. Immunol. Ther. Exp.

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“…The consideration of comorbidity prior to transplantation is even more relevant now that RIC transplantation has been shown to be effective in the treatment of MDS (reviewed in Oliansky et al 20 ).…”

Section: Comorbidity and Conditioning Intensitymentioning

confidence: 99%

Allogeneic Hematopoietic Stem-Cell Transplantation for Myelodysplastic Syndrome

Cutler

2010

Hematology

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Transplantation is the only known cure for myelodysplastic syndrome (MDS). While some comparative analyses have demonstrated early transplantation to be the preferred strategy for all MDS patients, many of these analyses are biased. Using newly identified prognostic factors and models, a rational approach to transplantation can be undertaken. Factors such as transfusion dependency, cytogenetics, medical comorbidity, and World Health Organization (WHO) histologic subtype should all be considered when deciding on the role of transplantation for the MDS patient. Unresolved issues in transplantation include the impact of pre-transplant tumor debulking with traditional chemotherapeutic agents or the new DNA hypomethylating agents, and the optimal timing of reduced-intensity conditioning transplantation for older patients or for those with medical comorbidities.Despite the approval of three novel agents for myelodysplastic syndrome (MDS) therapy, allogeneic hematopoietic stem-cell transplantation (HSCT) is the only known curative procedure for MDS. Transplantation for MDS occurs frequently, as MDS is currently the third most common indication for allogeneic HSCT as reported to the Center for International Blood and Marrow Transplantation Research. 1 MDS is a disease predominantly of older individuals, and with the increased use and acceptance of reduced intensity conditioning (RIC) into the eighth decade of life, it is anticipated that the number of transplantations for MDS will continue to increase in the coming years. As novel therapies emerge for MDS, it is imperative to determine the optimal role for and timing of HSCT in the MDS patient.Comparative registry analyses have documented the benefit of transplantation over conventional supportive and disease-modifying therapeutics in the treatment of MDS, 2 but this should not be interpreted as an indication for transplantation in all MDS patients. Despite the curative potential of HSCT, transplantation is not undertaken lightly, and careful consideration must be made regarding the appropriateness of each potential transplant recipient and the timing at which transplantation is offered. Despite this, all patients who are potential candidates for transplantation should be referred to a transplantation center early in their disease course so that a discussion regarding the appropriateness of transplantation can occur and a donor search can be initiated when appropriate. This review focuses on appropriate patient selection for HSCT for MDS. Timing of TransplantationThe timing of transplantation has always been the most controversial topic of discussion for both patients and physicians. Faced with the uncertainty of transplantation outcomes but the certainty of eventual MDS disease progression, decisions are often made based on patient preference. Supporting these decisions are a number of single-and multi-institution experiences that have demonstrated improved outcomes with early transplantation. It is clear that there is inherent bias in these types of analyses, because ...

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“…Several comprehensive evidence-based systematic reviews have addressed the role of hematopoietic cell transplantation (HCT) for patients with acute leukemia [1,2]. The treatment approaches and recommendations in these reviews were uniformly evaluated according to the grading of design and strength of evidence as well as for the strength of the treatment recommendation [3].…”

Section: Introductionmentioning

confidence: 99%

Allogeneic Hematopoietic Cell Transplantation for Adult Patients with Acute Leukemia: The Role of Meta-Analyses

Ram

Gafter‐Gvili²,

Shpilberg³

et al. 2010

Acta Haematol

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In spite of decades of research in the field of allogeneic hematopoietic cell transplantation for the treatment of acute leukemia, controversies regarding the role of transplant still exist. These stem not only from contradictory results of different studies, but also from differences in the design and the strength of evidence of the various trials. Meta-analysis is considered the highest level of evidence and as such has the power to resolve clinical issues comparing between different treatment modalities. The aim of this review is to examine the contribution of meta-analyses to the establishment of the role of hematopoietic transplantation for acute leukemia and at the same time to highlight limitations and future directions.

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The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Myelodysplastic Syndromes: An Evidence-Based Review

Cited by 72 publications

References 97 publications

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Allogeneic Hematopoietic Stem-Cell Transplantation for Myelodysplastic Syndrome

Allogeneic Hematopoietic Cell Transplantation for Adult Patients with Acute Leukemia: The Role of Meta-Analyses

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