Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults
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Authors
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
UMass Chan Affiliations
MedicineDocument Type
Journal ArticlePublication Date
2021-08-21
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Show full item recordAbstract
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.Source
Metheny L, Callander NS, Hall AC, Zhang MJ, Bo-Subait K, Wang HL, Agrawal V, Al-Homsi AS, Assal A, Bacher U, Beitinjaneh A, Bejanyan N, Bhatt VR, Bredeson C, Byrne M, Cairo M, Cerny J, DeFilipp Z, Perez MAD, Freytes CO, Ganguly S, Grunwald MR, Hashmi S, Hildebrandt GC, Inamoto Y, Kanakry CG, Kharfan-Dabaja MA, Lazarus HM, Lee JW, Nathan S, Nishihori T, Olsson RF, Ringdén O, Rizzieri D, Savani BN, Savoie ML, Seo S, van der Poel M, Verdonck LF, Wagner JL, Yared JA, Hourigan CS, Kebriaei P, Litzow M, Sandmaier BM, Saber W, Weisdorf D, de Lima M. Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults. Transplant Cell Ther. 2021 Nov;27(11):923.e1-923.e12. doi: 10.1016/j.jtct.2021.08.010. Epub 2021 Aug 21. PMID: 34428556; PMCID: PMC9064046.DOI
10.1016/j.jtct.2021.08.010Permanent Link to this Item
http://hdl.handle.net/20.500.14038/51889PubMed ID
34428556Rights
Copyright © 2021. Published by Elsevier Inc.ae974a485f413a2113503eed53cd6c53
10.1016/j.jtct.2021.08.010