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    Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults.

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    Author
    Metheny, Leland
    Callander, 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
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    Date
    2021-08-21
    Journal
    Transplantation and Cellular Therapy
    Publisher
    Elsevier Inc.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1016/j.jtct.2021.08.010
    Abstract
    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.
    Keyword
    Acute myelogenous leukemia
    Allogeneic transplantation
    Myelodysplasia
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/17546
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jtct.2021.08.010
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