Abstract
Poor prognostic factors, such as transfusion dependency and chromosomal risk, need to be considered in the indication of allogeneic hematopoietic cell transplantation (allo-HCT) for patients harboring myelodysplastic syndromes with less than 5% marrow blasts (MDS-Lo). We analyzed the post-transplant outcomes of 1229 MDS-Lo patients who received myeloablative (MAC)(n = 651), reduced-intensity (RIC)(n = 397), and non-myeloablative conditioning (NMAC) regimens (n = 181). The multivariate analysis revealed that the RIC group had better chronic graft-versus-host disease (GVHD)- and relapse-free survival (CRFS) (P = 0.021), and GVHD- and relapse-free survival (GRFS) than the MAC group (P = 0.001), while no significant differences were observed between the NMAC and MAC groups. In the subgroup analysis, the MAC group has better overall survival (P = 0.008) than the RIC group among patients with an HCT-comorbidity index (HCT-CI) score of 0, while the RIC group had better overall survival (P = 0.029) than the MAC group among those with an HCT-CI score ≥3. According to the type of conditioning regimen, total body irradiation 12 Gy-based MAC regimen showed better OS and CRFS than the other MAC regimen, and comparable outcomes to the RIC regimen. In conclusion, the RIC and NMAC regimens are promising options for MDS-Lo patients in addition to the MAC regimen.
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All data are available within the article or supplementary files or are available upon request from the corresponding author H.I. (itoman820hide@outlook.jp).
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Acknowledgements
This work was supported in part by the Takeda Science Foundation and a Grant-in-Aid for Scientific Research (KAKENHI) from the Japan Society for the Promotion of Science (22K08480 [Nagasaki; HI]). The authors would like to thank all the physicians and data managers at the various institutes who contributed valuable data on transplantation to the Japanese Society for Transplantation and Cellular Therapy (JSTCT), all the members of the data management committees of JSTCT, and all the members of “Adult Myelodysplastic Syndromes Working Group of the JSTCT”.
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HI and YM designed the research, organized the project, and wrote the manuscript. HI, YM, and MF analyzed the data. HI, YM, MF, and KI collected data from TRUMP. HI, YM, MF, JA, ND, TN, TF, NU, YUeda, YUehara, YK, SO, TK, KK, KM, TE, MO, TI, YA, and KI interpreted data and reviewed and approved the final manuscript.
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Itonaga, H., Miyazaki, Y., Fujioka, M. et al. Prognostic impact of the conditioning intensity on outcomes after allogeneic transplantation for MDS with low blasts: a nationwide retrospective study by the adult MDS working group of the Japan Society for Transplantation and Cellular Therapy. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02297-0
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DOI: https://doi.org/10.1038/s41409-024-02297-0
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