Allogeneic hematopoietic stem-cell transplantation for patients 50 years or older with myelodysplastic syndromes or secondary acute myeloid leukemia

Ziyi Lim, Ronald Brand, Rodrigo Martino, Anja Van Biezen, Jürgen Finke, Andrea Bacigalupo, Dietrich Beelen, Agnes Devergie, Emilio Alessandrino, Roel Willemze, Tapani Ruutu, Marc Boogaerts, Michele Falda, Jean Pierre Jouet, Dietger Niederwieser, Nicolaus Kroger, Ghulam J. Mufti, Theo M. De Witte

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients. Patients and Methods: We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC). Results: The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P <.01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P <.01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P = .01) was the major independent variable associated with an inferior 4-year overall survival. Conclusion: Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.

Original languageEnglish
Pages (from-to)405-411
Number of pages7
JournalJournal of Clinical Oncology
Volume28
Issue number3
DOIs
Publication statusPublished - Jan 20 2010

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

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