Unrelated bone marrow transplantation in patients with myelodysplastic syndromes and secondary acute myeloid leukemia: an EBMT survey

Abstract

Summary:The Chronic Leukemia Working Party of the EBMT has collected data on 118 patients of median age 24 years (range 0.3 to 53 years) who underwent an allogeneic bone marrow transplantation from unrelated donors for treatment of MDS or secondary AML (RA/RARS, n = 24; RAEB, n = 26; RAEB-t, n = 34; CMML, n = 12; sAML, n = 22) between 1986 and 1996. The data were reported by 49 EBMT centers. Thirtyfour of 118 patients are alive, relapse was the cause of death in 19 of 84 patients and the remaining patients died of transplant-related mortality. For the whole group the actuarial probability of survival at 2 years is 28%, disease-free survival 28%, relapse risk 35% and transplant-related mortality is 58%. The transplantrelated mortality is significantly influenced by the age of the recipient (Ͻ18 years 40%, 18-35 years 61%, Ͼ35 years 81%). The relapse rate after BMT is influenced by FAB classification of the disease at BMT. Patients with a low blast count (RA, RAEB) have a lower probability of relapse (13%, 15%) compared to patients with RAEB-t or sAML (29%, 45%). Furthermore, we found evidence of a graft-versus-leukemia effect in MDS/sAML. Patients with acute GVHD, grade II-IV, had a probability of relapse of 26% vs 42% in patients with no acute GVHD or grade I only. Allogeneic transplantation with an HLA-matched, unrelated donor may be offered to younger patients (age Ͻ35 years) with poor risk myelodysplasia or secondary AML. Keywords: unrelated BMT; MDS; sAML Myelodysplastic syndromes (MDS) are acquired clonal disorders of the hematopoietic stem cell characterized by ineffective hematopoiesis and progressive peripheral cytopenias. Infections due to neutropenia and thrombocytopenic bleeding are the most frequent causes of death. Ten to 40%

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

“…9,24,[34][35][36] However, a number of recent studies of RIC allo-HSCT have shown age to not be a significant factor affecting outcome. 5,23,32,37 In this study, although an advanced recipient age of more than 50 years showed an independent correlation with poorer OS (P ¼ 0.05), the use of the HCT-CI seemed to be a much stronger predictor of post-transplant outcomes.…”

“…[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.…”

Donor lymphocyte infusion to treat relapse after allogeneic bone marrow transplantation for myelodysplastic syndrome

“…[1][2][3][4] For younger patients having an HLA-matched donor, allogeneic bone marrow transplantation (BMT) provides the only potentially curative treatment with approximately 40% of treated individuals becoming long-term disease-free survivors. [5][6][7][8] Relapse after allogeneic BMT remains one of the major causes of treatment failure, and is responsible for about 50% of deaths. Only a minority of relapsed patients is cured with a second BMT, which itself results in significant morbidity and mortality.…”

Lack of cytoprotective effect of amifostine following HLA-identical sibling transplantation for advanced myelodysplastic syndrome (MDS): a pilot study

“…[2][3][4] Among patients with advanced disease (45% marrow blasts), 25-45% can be expected to survive in remission at 3 years after transplantation. [3][4][5] However, among patients with both advanced and less advanced MDS, nonrelapse mortality (NRM) has been in the range of 25-70%. 3,[5][6][7][8] Amifostine (Ethyol s ), also known as Walter Reed (WR)-2721, is a phosphorylated aminothiol compound originally developed by the WR Army Institute of Research as a potentially radioprotective agent for military personnel.…”

“…[3][4][5] However, among patients with both advanced and less advanced MDS, nonrelapse mortality (NRM) has been in the range of 25-70%. 3,[5][6][7][8] Amifostine (Ethyol s ), also known as Walter Reed (WR)-2721, is a phosphorylated aminothiol compound originally developed by the WR Army Institute of Research as a potentially radioprotective agent for military personnel. 9 Dephosphorylation to its active form WR-1065 occurs in normal tissues, but is almost negligible in tumors.…”