TY - JOUR
T1 - Allogeneic Stem Cell Transplantation for Advanced Myelodysplastic Syndrome
T2 - Comparison of Outcomes between CD34 + Selected and Unmodified Hematopoietic Stem Cell Transplantation
AU - Tamari, Roni
AU - Oran, Betul
AU - Hilden, Patrick
AU - Maloy, Molly
AU - Kongtim, Piyanuch
AU - Papadopoulos, Esperanza B.
AU - Rondon, Gabriela
AU - Jakubowski, Ann A.
AU - Andersson, Borje S.
AU - Devlin, Sean M.
AU - Ahmed, Sairah
AU - Popat, Uday R.
AU - Ponce, Doris
AU - Chen, Julianne
AU - Sauter, Craig
AU - Young, James W.
AU - de Lima, Marcos
AU - Perales, Miguel Angel
AU - O'Reilly, Richard J.
AU - Giralt, Sergio A.
AU - Champlin, Richard E.
AU - Castro-Malaspina, Hugo
N1 - Publisher Copyright:
© 2018 The American Society for Blood and Marrow Transplantation
PY - 2018/5
Y1 - 2018/5
N2 - In this study, we compared transplantation outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) in patients with advanced myelodysplastic syndrome (MDS) who received a CD34 + cell-selected and those who received an unmodified allograft. This analysis initially included 181 patients, 60 who received a CD34 + cell-selected transplant and 121 who received an unmodified transplant. Owing to significant differences in disease characteristics, the analysis was limited to patients with <10% blasts before HSCT (n = 145). Two groups were defined: low risk, with low- and intermediate-risk cytogenetics (CD34 + , n = 39; unmodified, n = 46), and high risk: poor and very poor risk cytogenetics (CD34 + , n = 19; unmodified, n = 41). In the low-risk group, the incidence of grade II-IV acute graft-versus-host disease (aGVHD) at 1 year post-transplantation was 18% in the CD34 + subgroup versus 41.3% in the unmodified subgroup (P =.015). There were no differences between the subgroups in the incidence of grade III-IV aGVHD. The incidence of chronic graft-versus-host disease (cGVHD) at 3 years in the 2 subgroups was 5.3% and 56%, respectively (P <.001). At 3 years post-transplantation, relapse, overall survival (OS), and relapse-free survival (RFS) were similar in the CD34 + and unmodified subgroups: 8.1% versus 19.4% (P =.187), 58.5% versus 53.7% (P =.51), and 59.5% versus 52.4% (P =.448). However, the composite outcome combining extensive cGVHD-free status and relapse-free status (CRFS) at 3 years was 59.5% in the CD34 + group versus 19.2% in the unmodified group (P <.001). In the high-risk group, grade II-IV aGVHD at 1 year was 31.6% in the CD34 + subgroup versus 24.4% in the unmodified subgroup (P =.752). There were no differences between the subgroups in the incidence of grade III-IV aGVHD. The incidence of cGVHD at 3 years in the 2 subgroups was 0% versus 27.6% (P =.013). At 3 years post-transplantation, relapse, OS, RFS, and CRFS in the 2 subgroups were 31.6% versus 69.3% (P =.007), 35.5% versus 14.5% (P =.068), 31.6% versus 10.7% (P =.045), and 31.6% versus 6.1% (P =.001), respectively. Cytogenetic abnormalities at diagnosis and transplant type had significant univariate associations with RFS in the high-risk cohort. Only cytogenetics (P =.03) remained associated with this outcome in a multivariate model. OS was similar in the 2 transplant groups; however, CRFS was superior in the CD34 + cell-selected transplant group.
AB - In this study, we compared transplantation outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) in patients with advanced myelodysplastic syndrome (MDS) who received a CD34 + cell-selected and those who received an unmodified allograft. This analysis initially included 181 patients, 60 who received a CD34 + cell-selected transplant and 121 who received an unmodified transplant. Owing to significant differences in disease characteristics, the analysis was limited to patients with <10% blasts before HSCT (n = 145). Two groups were defined: low risk, with low- and intermediate-risk cytogenetics (CD34 + , n = 39; unmodified, n = 46), and high risk: poor and very poor risk cytogenetics (CD34 + , n = 19; unmodified, n = 41). In the low-risk group, the incidence of grade II-IV acute graft-versus-host disease (aGVHD) at 1 year post-transplantation was 18% in the CD34 + subgroup versus 41.3% in the unmodified subgroup (P =.015). There were no differences between the subgroups in the incidence of grade III-IV aGVHD. The incidence of chronic graft-versus-host disease (cGVHD) at 3 years in the 2 subgroups was 5.3% and 56%, respectively (P <.001). At 3 years post-transplantation, relapse, overall survival (OS), and relapse-free survival (RFS) were similar in the CD34 + and unmodified subgroups: 8.1% versus 19.4% (P =.187), 58.5% versus 53.7% (P =.51), and 59.5% versus 52.4% (P =.448). However, the composite outcome combining extensive cGVHD-free status and relapse-free status (CRFS) at 3 years was 59.5% in the CD34 + group versus 19.2% in the unmodified group (P <.001). In the high-risk group, grade II-IV aGVHD at 1 year was 31.6% in the CD34 + subgroup versus 24.4% in the unmodified subgroup (P =.752). There were no differences between the subgroups in the incidence of grade III-IV aGVHD. The incidence of cGVHD at 3 years in the 2 subgroups was 0% versus 27.6% (P =.013). At 3 years post-transplantation, relapse, OS, RFS, and CRFS in the 2 subgroups were 31.6% versus 69.3% (P =.007), 35.5% versus 14.5% (P =.068), 31.6% versus 10.7% (P =.045), and 31.6% versus 6.1% (P =.001), respectively. Cytogenetic abnormalities at diagnosis and transplant type had significant univariate associations with RFS in the high-risk cohort. Only cytogenetics (P =.03) remained associated with this outcome in a multivariate model. OS was similar in the 2 transplant groups; however, CRFS was superior in the CD34 + cell-selected transplant group.
KW - Allogeneic transplantation
KW - Myelodysplastic syndrome
KW - T cell depletion
KW - Unmodified
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U2 - 10.1016/j.bbmt.2018.01.001
DO - 10.1016/j.bbmt.2018.01.001
M3 - Article
C2 - 29325829
AN - SCOPUS:85044169518
SN - 1083-8791
VL - 24
SP - 1079
EP - 1087
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -