Haematopoietic stem cell transplantation for patients with myelo- dysplastic syndromes and secondary acute myeloid leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)
Theo de Witte,Jo Hermans,Jaak M. Vossen,Andrea Bacigalupo,Giovanna Meloni,Niels Jacobsen,Tapani Ruutu,Per Ljungman,Alois Gratwohl,Volker Runde,Dietger Niederwieser,Anja van Biezen,Agnès Devergie,Jan Cornelissen,Jean-Pierre Jouet,Renate Arnold,Jane F. Apperley +16 more
TLDR
Allogeneic stem cell transplantation from an HLA‐identical sibling donor is a curative treatment option for a young patient with myelodysplastic syndrome, limited by age and lack of sibling donors.Abstract:
Allogeneic stem cell transplantation from an HLA-identical sibling donor is a curative treatment option for a young patient with myelodysplastic syndrome, limited by age and lack of sibling donors. Alternative stem cell sources have been used more recently, such as unrelated donors, non-identical family members or autologous transplants. This analysis of 1378 transplants reported to the European Group for Blood and Marrow Transplantation (EBMT) addresses the outcome of the varying procedures according to the known risk factors. The estimated disease-free survival (DFS) and estimated relapse risk at 3 years were both 36% for 885 patients transplanted with stem cells from matched siblings. In the multivariate analysis, age and stage of disease had independent prognostic significance for DFS, survival and treatment-related mortality. Patients transplanted at an early stage of disease had a significantly lower risk of relapse than patients transplanted at more advanced stages. The estimated DFS at 3 years was 25% for the 198 patients with voluntary unrelated donors, 28% for the 91 patients with alternative family donors and 33% for the 126 patients autografted in first complete remission. The non-relapse mortality was 58% for patients with unrelated donors, 66% for patients with non-identical family donors and 25% for autografted patients. The relapse rate of 18% was relatively low for patients with non-identical family donors, 41% for patients with unrelated donors and 55% for patients treated with autologous stem cell transplantation. Both allogeneic and autologous stem cell transplantation have emerged as treatment options for patients with myelodysplastic syndromes. Transplantation with an HLA-identical sibling donor is the preferred treatment option. Patients without an HLA-identical sibling donor may be treated with either autologous stem cell transplantation or an alternative donor transplantation. Patients younger than 20 years may be treated with an unrelated donor transplantation. Patients older than 40 years, and probably also patients between 20 and 40 years, may benefit most from an autologous stem cell transplantation.read more
Citations
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Journal ArticleDOI
Prognostic Factors and Life Expectancy in Myelodysplastic Syndromes Classified According to WHO Criteria: A Basis for Clinical Decision Making
Luca Malcovati,Matteo G. Della Porta,Cristiana Pascutto,Rosangela Invernizzi,Marina Boni,Erica Travaglino,Francesco Passamonti,Luca Arcaini,Margherita Maffioli,Paolo Bernasconi,Mario Lazzarino,Mario Cazzola +11 more
TL;DR: Data show that the WHO classification of MDSs has a relevant prognostic value, and this classification, along with cytogenetics, might be useful in decisions regarding transplantation.
Journal ArticleDOI
A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome
Corey Cutler,Stephanie J. Lee,Peter L. Greenberg,H. Joachim Deeg,Waleska S. Pérez,Claudio Anasetti,Brian J. Bolwell,Mitchell S. Cairo,Robert Peter Gale,John P. Klein,Hillard M. Lazarus,Jane L. Liesveld,Philip L. McCarthy,Gustavo Milone,J. Douglas Rizzo,Kirk R. Schultz,Michael E. Trigg,Armand Keating,Daniel J. Weisdorf,Joseph H. Antin,Mary M. Horowitz +20 more
TL;DR: A Markov model constructed to examine 3 transplantation strategies for newly diagnosed MDS found that delayed BMT is associated with maximal life expectancy, whereas immediate transplantation for intermediate-2- and high-risk disease is associated for low- and intermediate-1-risk patients.
Journal ArticleDOI
Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet
Luca Malcovati,Eva Hellström-Lindberg,David G. Bowen,Lionel Ades,Jaroslav Cermak,Consuelo del Cañizo,Matteo G. Della Porta,Pierre Fenaux,Norbert Gattermann,Ulrich Germing,Joop H. Jansen,Moshe Mittelman,Ghulam J. Mufti,Uwe Platzbecker,Guillermo Sanz,Dominik Selleslag,Mette Skov-Holm,Reinhard Stauder,Argiris Symeonidis,Arjan A. van de Loosdrecht,Theo de Witte,Mario Cazzola +21 more
TL;DR: Within the myelodysplastic syndrome (MDS) work package of the European LeukemiaNet, an Expert Panel was selected according to the framework elements of the National Institutes of Health Consensus Development Program and Guidelines were developed on the basis of a list of patient- and therapy-oriented questions.
Journal ArticleDOI
Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes: Consensus statements and report from a working conference
Peter Valent,Hans-Peter Horny,John M. Bennett,Christa Fonatsch,Ulrich Germing,Peter L. Greenberg,Torsten Haferlach,Detlef Haase,H. J. Kolb,Otto Krieger,Michael R. Loken,Arjan A. van de Loosdrecht,Kiyoyuki Ogata,Alberto Orfao,Michael Pfeilstöcker,Björn Rüter,Wolfgang R. Sperr,Reinhard Stauder,Denise A. Wells +18 more
TL;DR: Concerning the diagnostic interface, minimal diagnostic criteria for MDS are proposed, and for patients with unexplained cytopenia who do not fulfill these criteria, the term 'idiopathic cy topenia of uncertain significance' (ICUS) is suggested.
Journal ArticleDOI
Comorbidity and Disease Status–Based Risk Stratification of Outcomes Among Patients With Acute Myeloid Leukemia or Myelodysplasia Receiving Allogeneic Hematopoietic Cell Transplantation
Mohamed L. Sorror,Brenda M. Sandmaier,Barry E. Storer,Michael B. Maris,Frédéric Baron,David G. Maloney,Bart L. Scott,H. Joachim Deeg,Frederick R. Appelbaum,Rainer Storb +9 more
TL;DR: Patients with low comorbidity scores could be candidates for prospective randomized trials comparing nonmyeloablatives and myeloablative conditioning regardless of disease status, and novel antitumor agents combined with nonmyelablative HCT should be explored among patients with high comorbridity scores and advanced disease.
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Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia.
A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome
Corey Cutler,Stephanie J. Lee,Peter L. Greenberg,H. Joachim Deeg,Waleska S. Pérez,Claudio Anasetti,Brian J. Bolwell,Mitchell S. Cairo,Robert Peter Gale,John P. Klein,Hillard M. Lazarus,Jane L. Liesveld,Philip L. McCarthy,Gustavo Milone,J. Douglas Rizzo,Kirk R. Schultz,Michael E. Trigg,Armand Keating,Daniel J. Weisdorf,Joseph H. Antin,Mary M. Horowitz +20 more