Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults.
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Author
Metheny, LelandCallander, Natalie S
Hall, Aric C
Zhang, Mei-Jei
Bo-Subait, Khalid
Wang, Hai-Lin
Agrawal, Vaibhav
Al-Homsi, A Samer
Assal, Amer
Bacher, Ulrike
Beitinjaneh, Amer
Bejanyan, Nelli
Bhatt, Vijaya Raj
Bredeson, Chris
Byrne, Michael
Cairo, Mitchell
Cerny, Jan
DeFilipp, Zachariah
Perez, Miguel Angel Diaz
Freytes, César O
Ganguly, Siddhartha
Grunwald, Michael R
Hashmi, Shahrukh
Hildebrandt, Gerhard C
Inamoto, Yoshihiro
Kanakry, Christopher G
Kharfan-Dabaja, Mohamed A
Lazarus, Hillard M
Lee, Jong Wook
Nathan, Sunita
Nishihori, Taiga
Olsson, Richard F
Ringdén, Olov
Rizzieri, David
Savani, Bipin N
Savoie, Mary Lynn
Seo, Sachiko
van der Poel, Marjolein
Verdonck, Leo F
Wagner, John L
Yared, Jean A
Hourigan, Christopher S
Kebriaei, Partow
Litzow, Mark
Sandmaier, Brenda M
Saber, Wael
Weisdorf, Daniel
de Lima, Marcos
Date
2021-08-21Journal
Transplantation and Cellular TherapyPublisher
Elsevier Inc.Type
Article
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Patients who develop therapy-related myeloid neoplasm, either myelodysplastic syndrome (t-MDS) or acute myelogenous leukemia (t-AML), have a poor prognosis. An earlier Center for International Blood and Marrow Transplant Research (CIBMTR) analysis of 868 allogeneic hematopoietic cell transplantations (allo-HCTs) performed between 1990 and 2004 showed a 5-year overall survival (OS) and disease-free survival (DFS) of 22% and 21%, respectively. Modern supportive care, graft-versus-host disease prophylaxis, and reduced-intensity conditioning (RIC) regimens have led to improved outcomes. Therefore, the CIBMTR analyzed 1531 allo-HCTs performed in adults with t-MDS (n = 759) or t-AML (n = 772) between and 2000 and 2014. The median age was 59 years (range, 18 to 74 years) for the patients with t-MDS and 52 years (range, 18 to 77 years) for those with t-AML. Twenty-four percent of patients with t-MDS and 11% of those with t-AML had undergone a previous autologous (auto-) HCT. A myeloablative conditioning (MAC) regimen was used in 49% of patients with t-MDS and 61% of patients with t-AML. Nonrelapse mortality at 5 years was 34% (95% confidence interval [CI], 30% to 37%) for patients with t-MDS and 34% (95% CI, 30% to 37%) for those with t-AML. Relapse rates at 5 years in the 2 groups were 46% (95% CI, 43% to 50%) and 43% (95% CI, 40% to 47%). Five-year OS and DFS were 27% (95% CI, 23% to 31%) and 19% (95% CI, 16% to 23%), respectively, for patients with t-MDS and 25% (95% CI, 22% to 28%) and 23% (95% CI, 20% to 26%), respectively, for those with t-AML. In multivariate analysis, OS and DFS were significantly better in young patients with low-risk t-MDS and those with t-AML undergoing HCT with MAC while in first complete remission, but worse for those with previous auto-HCT, higher-risk cytogenetics or Revised International Prognostic Scoring System score, and a partially matched unrelated donor. Relapse remains the major cause of treatment failure, with little improvement seen over the past 2 decades. These data mandate caution when recommending allo-HCT in these conditions and indicate the need for more effective antineoplastic approaches before and after allo-HCT.Rights/Terms
Copyright © 2021. Published by Elsevier Inc.Identifier to cite or link to this item
http://hdl.handle.net/10713/17546ae974a485f413a2113503eed53cd6c53
10.1016/j.jtct.2021.08.010
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