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

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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.

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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.”

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Authors and Affiliations

  1. Department of Hematology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Japan

    Hidehiro Itonaga & Yasushi Miyazaki

  2. Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan

    Ken Ishiyama

  3. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Kazunari Aoki

  4. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    Jun Aoki

  5. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan

    Takayuki Ishikawa

  6. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  7. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Kazuteru Ohashi

  8. Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Kurashiki, Japan

    Yasunori Ueda

  9. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  10. Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Gunma, Japan

    Toru Sakura

  11. Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Yuju Ohno

  12. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Koji Iwato

  13. Department of Internal Medicine (Hematology), Toyama Prefectural Central Hospital, Toyama, Japan

    Hirokazu Okumura

  14. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tadakazu Kondo

  15. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  16. Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan

    Minoko Takanashi

  17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  18. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  19. Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan

    Yasushi Miyazaki

Authors
  1. Hidehiro Itonaga
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  2. Ken Ishiyama
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  3. Kazunari Aoki
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  4. Jun Aoki
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  5. Takayuki Ishikawa
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  6. Naoyuki Uchida
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  7. Kazuteru Ohashi
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  8. Yasunori Ueda
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  9. Takahiro Fukuda
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  10. Toru Sakura
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  11. Yuju Ohno
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  12. Koji Iwato
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  13. Hirokazu Okumura
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  14. Tadakazu Kondo
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  15. Tatsuo Ichinohe
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  16. Minoko Takanashi
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  17. Yoshiko Atsuta
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  18. Yasushi Miyazaki
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Contributions

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.

Corresponding author

Correspondence to Hidehiro Itonaga.

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Appendix

Appendix

The following institutions and hematologists contributed to this study: Nagasaki University: Dr. H. Itonaga and Dr. Y. Miyazaki; Kyoto University: Dr. A. Takeda and Dr. K. Aoki; Kanagawa Cancer Center: Dr. J. Aoki, Dr. M. Tanaka, and Dr. T Takahana; Kanazawa University Hospital: Dr. K. Ishiyama; Kobe City Medical General Hospital: Dr. Y. Shimomura and Dr. T. Ishikawa; Keio University School of Medicine: Drs. J. Kato and S. Okamoto; Japanese Red Cross Nagoya First Hospital: Dr. Y. Ozawa; Tokyo Metropolitan Cancer and Infectious Disease Centre Komagome Hospital: Drs. K. Kakizoe and N. Doki; JA Aichi Konan Kosei Hospital: Dr. A. Kohno; Toranomon Hospital: Dr. S. Takagi; Aichi Medical University: Dr. A. Takami; Hyogo College of Medicine: Dr. H. Tamaki; Akita University Hospital: Dr. M. Hirokawa; Mishuku Hospital: Dr. K. Masuoka; Niigata University: Dr. M. Masuko; Kinki University: Dr. K. Ashizawa and Dr. T. Ashida; NTT Medical Center Tokyo: Dr. R. Kida and Dr. K. Usuki; Hamanomachi Hospital: Dr. T. Eto; Sapporo Hokuyu Hospital: Dr. K. Minauchi and Dr. S. Ohta; Tohoku University Hospital: Dr. Y. Onishi; Kanazawa University Graduate School of Medical Sciences: Dr. S. Nakao; Shizuoka Cancer Center: Dr. T. Enami and Dr. T. Ikeda; Kansai Medical University Hirakata Hospital: Dr. K. Ishii; Tokyo Metropolitan Geriatric Hospital: Dr. S. Kobayashi; Tokai University School of Medicine: Dr. S. Machida; Osaka City University: Dr. H. Koh; National Cancer Center Hospital: Dr. T. Suzuki; The University of Tokyo: Dr. T. Konuma; Nagoya University Graduate School of Medicine: Dr. K. Miyao and Dr. T. Morishita; Tokyo Women’s Medical University: Dr. K. Yoshinaga; Ishikawa Prefectural Central Hospital: Dr. Y. Mizumaki and Dr. C. Sugimori; Kokura Memorial Hospital: Dr. A. Yonezawa; Okawama University Hospital: Dr. S. Fujii.

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Itonaga, H., Ishiyama, K., Aoki, K. et al. Increased opportunity for prolonged survival after allogeneic hematopoietic stem cell transplantation in patients aged 60–69 years with myelodysplastic syndrome. Ann Hematol 98, 1367–1381 (2019). https://doi.org/10.1007/s00277-019-03653-7

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