| Title | Comparison of Upfront Transplantation and Pretransplant Cytoreductive Therapy for Advanced Myelodysplastic Syndrome |
| Authors | Wang, Hong Li, Yan Xu, Qingyu Zhou, Wei Yin, Chengliang Wang, Ruiqi Wang, Mengzhen Xu, Yuanyuan Li, Yonghui Yu, Li |
| Affiliation | Nankai Univ, Sch Med, Tianjin, Peoples R China Chinese Peoples Liberat Army Gen Hosp, Dept Hematol, Beijing, Peoples R China Shenzhen Univ, Hlth Sci Ctr, Dept Hematol & Oncol,Clin Med Acad,Gen Hosp, Int Canc Ctr,Shenzhen Key Lab Precis Med Hematol, Xueyuan AVE 1098, Shenzhen, Guangdong, Peoples R China Peking Univ, Third Hosp, Dept Hematol, Beijing, Peoples R China Heidelberg Univ, Med Fac Mannheim, Dept Hematol & Oncol, Mannheim, Germany Macau Univ Sci & Technol, Fac Med, Taipa, Macao, Peoples R China Chinese Peoples Liberat Army Gen Hosp, Med Innovat Res Div, Med Big Data Res Ctr, Beijing, Peoples R China Chinese Peoples Liberat Army Gen Hosp, Natl Engn Lab Med Big Data Applicat Technol, Beijing, Peoples R China |
| Keywords | STEM-CELL TRANSPLANTATION INTENSIVE CHEMOTHERAPY MARROW TRANSPLANTATION INDUCTION CHEMOTHERAPY IDENTICAL SIBLINGS SOCIETE FRANCAISE EUROPEAN-SOCIETY AZACITIDINE IMPACT ADULTS |
| Issue Date | Sep-2021 |
| Publisher | CLINICAL LYMPHOMA MYELOMA & LEUKEMIA |
| Abstract | The value of pretransplant cytoreductive therapy for patients with advanced MDS remains controversial. This retrospective study including 69 cases showed that patients with upfront transplantation achieved outcomes similar to those receiving pretransplant cytoreduction. Achieving remission before transplantation led to better survival. This indicates the value of timely transplantation for advanced MDS and suitable pretransplant therapy during the donor search. Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative therapy for advanced myelodysplastic syndrome (MDS). However, the value of pretransplant cytoreduction remains debatable. Patients and Methods: We retrospectively compared the outcomes of upfront transplantation and pretransplant cytoreduction. Of 69 patients, 39 received upfront alto-HSCT and 30 received pretransplant cytoreduction, including chemotherapy (n = 16), hypomethylating agents (HMAs, n = 6), and HMAs with chemotherapy (n = 8). Results: The upfront group achieved similar overall survival (OS) and a trend of better progression-free survival (PFS) from diagnosis compared with the cytoreduction group (3-year PFS, 64.0% vs. 44.4%, P = .076). Posttransplant outcomes were comparable between the two groups in terms of OS, relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM). In patients with >= 2 mutations, the upfront group achieved better OS and PFS (3-year OS, 100.0% vs. 68.6%, P = .044; 3-year PFS: 92.3% vs. 43.9%, P = .016) than the cytoreduction group. Patients achieving remission in the cytoreduction group had outcomes similar to the upfront group, but those without remission before transplantation had a significantly worse posttransplant OS (3-year OS, 46.7% vs. 75.7%, P = .038). Patients with pretransplant HMAs had better PFS than those with chemotherapy or HMAs plus chemotherapy (P < 0.05). Conclusion: Compared with pretransplant cytoreduction, upfront allo-HSCT might provide more benefit to some patients with advanced MDS if there are suitable donors. HMAs would be a good alternative during the donor search. (C) 2021 Elsevier Inc. All rights reserved. |
| URI | http://hdl.handle.net/20.500.11897/624072 |
| ISSN | 2152-2650 |
| DOI | 10.1016/j.clml.2021.04.015 |
| Indexed | SCI(E) |
| Appears in Collections: | 第三医院 |
