期刊
BLOOD
卷 110, 期 4, 页码 1379-1387出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2007-02-076307
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- NCI NIH HHS [CA18029, CA15704, CA78902, P30 CA015704, P01 CA018029, P01 CA078902] Funding Source: Medline
- NHLBI NIH HHS [HL36444, P01 HL036444] Funding Source: Medline
We analyzed outcomes after hematopoietic cell transplantation (HCT) in 257 patients, 3 to 72.7 years old (median, 43 y), with secondary myelodysplastic syndrome (MDS) including those with transformation to acute myeloid leukemia (tAML). Conditioning regimens included high-dose total-body irradiation (TBI)/chemotherapy (n = 83); busulfan (BU)/ cyclophosphamide (CY) (BUCY, n = 122; with BU targeting [tBUCY], n = 93); fludarabine (Flu) with tBU (FLUtBU; n = 12); Flu plus 200 cGy TBI (n = 26); and miscellaneous regimens (n = 14). Donors were HLA-identical or partially mismatched family members in 135 and unrelated individuals in 122 patients. Five-year relapse-free survival was highest (43%) and non-relapse mortality lowest (28%) among tBUCY-conditioned patients. Outcomes were compared with results in 339 patients who received transplants for de novo MDS/tAML, and a multivariate analysis failed to show significant differences in outcome between the 2 cohorts. Relapse probability and relapse-free survival correlated significantly with disease stage (P <.001) and karyotype (P <.001). Relapse incidence was lower (P =.003) and relapse-free survival superior (P=.02) with unrelated donor transplants. The data suggest that overall inferior outcome in patients with secondary MDS/tAML was related to the frequency of high-risk cytogenetics. For both cohorts, transplantation outcomes improved over the time interval studied.
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