Impact of treatments before allogeneic hematopoietic stem cell transplantation in patients with higher-risk myelodysplastic syndrome

Zhang, Yupei; Liu, Chao; Zhang, Ran; Shi, Yong; Li, Xue; Yu, Jifeng; Wan, Dingming; Xie, Xinsheng

doi:10.1016/j.leukres.2022.106997

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…[5][6][7] If the donor is suitable, upfront transplantation may prolong survival in high-risk MDS patients, which may also increase the incidence of cGVHD. [8] However, this patient poses unique challenges, and little is known about the ideal treatment sequence and timing. The theoretical advantages of no conditioning regimen are the absence of chemotherapy-induced toxicity and the lower incidence of GVHD; however, there is little chance for donor myeloid engraftment.…”

Section: Discussionmentioning

confidence: 99%

Allogeneic stem cell transplantation without preconditioning in a child with therapy-related myelodysplastic syndrome: A case report

et al. 2023

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Rationale: Infants with mixed-lineage leukemia (MLL)-rearranged leukemia are usually refractory to standard induction therapy and are not immediate candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Chromosome 11q23 translocations, resulting in MLL rearrangement, have been well characterized in infant acute lymphoblastic leukemia (ALL). While t(4;11) ALL continues to have carry a bleak prognosis, patients with therapy-related myelodysplastic syndrome (t-MDS) have a shorter median overall survival than those compared with de novo MDS. Patient concerns: We describe a child with t-MDS who evolved from MLL-rearranged ALL and was successfully treated with HSCT without toxic preconditioning. Diagnoses: MDS diagnosis was based on morphological characteristics of bone marrow dysplasia in patients with clinical manifestations evidence of hematopoiesis impairments by different combinations of anemia, leukopenia, neutropenia, and thrombocytopenia. Interventions: Although the best donor for allo-HSCT is generally considered an human leukocyte antigen-matched sibling, only ~ 30% of patients have a suitable sibling. HSCT from an unrelated donor is a suitable option for patients with t-MDS who do not have matched sibling donors. Outcomes: Allo-HSCT without recipient preconditioning could be a promising treatment option for t-MDS, especially for patients with recurrent or persistent infections. Lessons: Cytogenetics, prognosis, and treatment of t-MDS are briefly discussed. Preconditioning before allo-HSCT seriously damages immune function. This work reviews our experience with a patient with t-MDS following ALL complicated by recurrent infections, and highlights our choice to omit preconditioning from allo-HSCT.

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