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Increased opportunity for prolonged survival after allogeneic hematopoietic stem cell transplantation in patients aged 60–69 years with myelodysplastic syndrome

  • Hidehiro ItonagaEmail author
  • Ken Ishiyama
  • Kazunari Aoki
  • Jun Aoki
  • Takayuki Ishikawa
  • Naoyuki Uchida
  • Kazuteru Ohashi
  • Yasunori Ueda
  • Takahiro Fukuda
  • Toru Sakura
  • Yuju Ohno
  • Koji Iwato
  • Hirokazu Okumura
  • Tadakazu Kondo
  • Tatsuo Ichinohe
  • Minoko Takanashi
  • Yoshiko Atsuta
  • Yasushi Miyazaki
Original Article

Abstract

We conducted a nationwide retrospective study to evaluate the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 651 patients aged 60–69 years with de novo myelodysplastic syndrome (MDS). We divided patients into two groups: 152 and 499 patients with an early and advanced disease status, respectively. The 3-year overall survival (OS) rate of patients with an early disease status was 45.9% (95% confidence interval [CI], 37.0 to 54.2%). A multivariate analysis revealed five adverse factors for OS: performance status (PS) 2–4 (hazard ratio [HR] 4.48; P < .001), poor cytogenetic risk group (HR 1.83; P = .041), male recipient (HR 2.58; P = .003), use of HLA-mismatched related grafts (HR 4.75; P = .003), and unrelated cord blood (HR 2.47; P = .023). The 3-year OS rate of patients with an advanced disease status was 37.2% (95% CI 32.4 to 41.9%). Five factors correlated with worse OS: PS 2–4 (HR 1.72; P = .003), poor cytogenetic risk group (HR 1.49; P = .003), use of HLA-mismatched related grafts (HR 1.96; P = .015), unrelated cord blood (HR 2.05; P < .001), and the high number of red blood cell transfusions before transplantation (HR 1.85; P = .018). The present results revealed the more frequent utilization of allo-HSCT for MDS patients aged 60–69 years, which increases the curative potential.

Keywords

Myelodysplastic syndrome Allogeneic hematopoietic stem cell transplantation Elderly GVHD-free and relapse-free survival 

Notes

Acknowledgments

This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development, AMED.

The authors would like to thank all the physicians and data managers at the various institutes who contributed valuable data on transplantation to the Japan Society for Hematopoietic Cell Transplantation (JSHCT) and all the members of the data management committees of JSHCT; a complete membership list of the “Adult Myelodysplastic Syndrome Working Group of the JSHCT” appears in the “Appendix.”

Author’s contribution

H.I. and Y.M. designed the research, organized the project, analyzed the data, and wrote the manuscript. H.I., K. Ishiyama, K.A., J.A., T. Ishikawa, and Y.M. collected data from TRUMP. H.I., K. Ishiyama, K.A., J.A., T. Ishikawa, N.A., K.O., Y.U., T.F., T.S., Y.O., K. Iwato, H.O., T.K., T. Ichinohe, M.T., Y.A., and Y.M. interpreted data, and reviewed and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

277_2019_3653_MOESM1_ESM.docx (300 kb)
Supplemental Figure 1 (DOCX 299 kb)
277_2019_3653_MOESM2_ESM.docx (80 kb)
Supplemental Table 1 (DOCX 80 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hidehiro Itonaga
    • 1
    Email author
  • Ken Ishiyama
    • 2
  • Kazunari Aoki
    • 3
  • Jun Aoki
    • 4
  • Takayuki Ishikawa
    • 5
  • Naoyuki Uchida
    • 6
  • Kazuteru Ohashi
    • 7
  • Yasunori Ueda
    • 8
  • Takahiro Fukuda
    • 9
  • Toru Sakura
    • 10
  • Yuju Ohno
    • 11
  • Koji Iwato
    • 12
  • Hirokazu Okumura
    • 13
  • Tadakazu Kondo
    • 14
  • Tatsuo Ichinohe
    • 15
  • Minoko Takanashi
    • 16
  • Yoshiko Atsuta
    • 17
    • 18
  • Yasushi Miyazaki
    • 1
    • 19
  1. 1.Department of HematologyNagasaki University HospitalNagasakiJapan
  2. 2.Department of HematologyKanazawa University HospitalKanazawaJapan
  3. 3.Department of Hematology and Oncology, Graduate School of MedicineKyoto UniversityKyotoJapan
  4. 4.Department of HematologyKanagawa Cancer CenterYokohamaJapan
  5. 5.Department of HematologyKobe City Medical Center General HospitalKobeJapan
  6. 6.Department of HematologyFederation of National Public Service Personnel Mutual Aid Associations Toranomon HospitalTokyoJapan
  7. 7.Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
  8. 8.Department of Hematology/Oncology and Transfusion and Hemapheresis CenterKurashiki Central HospitalKurashikiJapan
  9. 9.Department of Hematopoietic Stem Cell TransplantationNational Cancer Center HospitalTokyoJapan
  10. 10.Leukemia Research CenterSaiseikai Maebashi HospitalMaebashiJapan
  11. 11.Department of Internal MedicineKitakyushu Municipal Medical CenterKitakyushuJapan
  12. 12.Department of HematologyHiroshima Red Cross Hospital & Atomic-bomb Survivors HospitalHiroshimaJapan
  13. 13.Department of Internal Medicine (Hematology)Toyama Prefectural Central HospitalToyamaJapan
  14. 14.Department of Hematology and Oncology, Graduate School of MedicineKyoto UniversityKyotoJapan
  15. 15.Department of Hematology and Oncology, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
  16. 16.Blood Service HeadquartersJapanese Red Cross SocietyTokyoJapan
  17. 17.Japanese Data Center for Hematopoietic Cell TransplantationNagoyaJapan
  18. 18.Department of Healthcare AdministrationNagoya University Graduate School of MedicineNagoyaJapan
  19. 19.Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease InstituteNagasaki UniversityNagasakiJapan

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