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Response to pretransplant hypomethylating agents influences the outcome of allogeneic hematopoietic stem cell transplantation in adults with myelodysplastic syndromes
Author(s) -
Yahng SeungAh,
Yoon JaeHo,
Shin SeungHwan,
Lee SungEun,
Cho ByungSik,
Lee DongGun,
Eom KiSeong,
Lee Seok,
Min ChangKi,
Kim HeeJe,
Cho SeokGoo,
Kim DongWook,
Lee JongWook,
Min WooSung,
Kim TaiGyu,
Park ChongWon,
Kim YooJin
Publication year - 2013
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12038
Subject(s) - medicine , hazard ratio , gastroenterology , myelodysplastic syndromes , multivariate analysis , hematopoietic stem cell transplantation , transplantation , myeloid leukemia , international prognostic scoring system , leukemia , oncology , bone marrow , confidence interval
This study describes a retrospective analysis on the transplant outcome of 56 consecutive patients with myelodysplastic syndrome ( MDS ) according to their response to hypomethylating agents ( HMA ). While 2‐yr disease‐free survival ( DFS ) of patients who transformed to acute myeloid leukemia ( n = 12) was 25%, that of the remaining patients with MDS according to response to HMA was 73.1%, 68.1%, 50.0%, and 20.8% in G‐ COR (group of continuous response, n = 19), G ‐ N o C (group of no change, n = 15), G ‐ LOR (group of loss of response, n = 6), and G ‐ DP (group of disease progression, n = 4), respectively. When dichotomized as G ‐ COR / G ‐ N o C versus G ‐ LOR / G ‐ DP , significantly different 2‐yr DFS (71.0% vs. 33.3%; P = 0.004) and relapse (14.1% vs. 46.7%; P = 0.016) were demonstrated. On multivariate analysis, G ‐ LOR / G ‐ DP [hazard ratio ( HR ), 3.91; P = 0.008] and poor karyotype at transplantation ( HR , 2.69; P = 0.017) were the significant predictors for poor DFS , as G ‐ LOR / G ‐ DP was for relapse ( HR , 6.28; P = 0.011). DFS was significantly poor in patients with any of the two predictors in all MDS (81.5% vs. 34.9%; P = 0.001) or higher‐risk MDS ( H r MDS ) at the time of HMA (80.7% vs. 29.2%; P = 0.005). G‐ COR showed a trend of better DFS compared with G ‐ N o C among H r MDS (74.6% vs. 36.5%; P = 0.090). These results implicate the significance of response to HMA on hematopoietic stem cell transplantation ( HSCT ) outcomes and support the need for future study to verify the suggested strategy of proceeding to transplantation before LOR or DP , especially for H r MDS .