MDS disease characteristics, not donor source, predict hematopoietic stem cell transplant outcomes

Abstract

Myelodysplastic syndrome (MDS) is a heterogeneous group of hematologic malignancies with considerably variable prognosis and curable only with hematopoietic cell transplantation (HCT). Few studies comparing MDS HCT outcomes between sibling and UCB donors exist. Using the U of MN Blood and Marrow Transplant (BMT) database we retrospectively analyzed HCT outcomes among 89 MDS patients undergoing either sibling or double UCB HCT in 2000–2013. We observed similar survival, relapse, and non-relapse mortality (NRM) between sibling and UCB donor sources. Relapse was increased in those with Monosomal karyotype (MK) (p=0.04) and with RIC (reduced intensity conditioning) (P<0.01). In summary, our data highlight similar MDS HCT outcomes regardless of donor source and support the use of UCB as an alternative donor when a sibling is unavailable.

Factors predicting early mortality after new diagnosis of myelodysplastic syndrome: A population‐based study

“…Higher‐risk patients, having increased risk of leukemic transformation and lower overall survival, are treated with chemotherapy, hypomethylating agents such as azacitidine and decitabine, or allogeneic hematopoietic stem cell transplant (HSCT). Despite all the recent advances mentioned above, HSCT remains the only curative therapy for MDS …”

“…Despite all the recent advances mentioned above, HSCT remains the only curative therapy for MDS. 1, [8][9][10][12][13][14] To gauge the impact of non-hematologic medical comorbidities on survival in MDS, the MDS Comorbidity Index (MDS-CI) was developed and can be combined with IPSS-R and the WHO Classification-Based Prognostic Scoring System (WPSS) to refine prognostication. 15,16 This development represents one of the first probes into the relationship between patient and disease factors and survival in MDS.…”

Haploidentical Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndrome

“…MK was the other independent risk factor for poorer OS in our multivariate analysis, also in accordance with the CIBMTR scoring system. Several studies have identified MK as a negative predictor of outcomes in patients with MDS following allo-HSCT [36,37]. We found that haplo-HSCT could not overcome the poor prognostic significance of MK in patients with MDS, particularly in patients age ≥30 years (prognostic score, 5 to 7), and other approaches to improving the clinical outcomes of these patients with MDS should be considered.…”