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International Journal of Hematology

, Volume 85, Issue 5, pp 446–455 | Cite as

The Beneficial Effect of Chronic Graft-versus-Host Disease on the Clinical Outcome of Transplantation with Fludarabine/Busulfan-Based Reduced-Intensity Conditioning for Patients with De Novo Myelodysplastic Syndrome

  • Byung-Sik Cho
  • Yoo-Jin Kim
  • Seok-Goo Cho
  • Sung-Yong Kim
  • Ki-Seong Eom
  • Hee-Je Kim
  • Seok Lee
  • Chang-Ki Min
  • Dong-Wook Kim
  • Jong-Wook Lee
  • Woo-Sung Min
  • Chun-Choo Kim
Article

Abstract

Allogeneic hematopoietic stem cell transplantation following reduced-intensity stem cell transplantation (RIST) has enabled the treatment of older or medically infirm patients with myeloid malignancies; however, determining the value of RIST outcomes for myelodysplastic syndrome (MDS) is difficult because of the heterogeneity of the diseases included in most trials. To define the role of RIST in MDS, we performed RIST for 22 consecutive patients who had de novo MDS as classified by World Health Organization (WHO) criteria and who received an allograft with fludarabine/busulfan (Busulfex) or fludarabine/Busulfex/antithymocyte globulin (ATG) conditioning. Nineteen patients (86.4%) achieved engraftment. At a median follow-up of 18.9 months (range, 13.1–24.8 months), the estimated 2-year rates of overall survival, event-free survival (EFS), transplantation-related mortality, and relapse were 78.7%, 67.7%, 12.6%, and 22.5%, respectively. Acute graft-versus-host disease (GVHD) greater than grade II developed in 3 patients (15.8%). Chronic GVHD developed in 10 patients (55.6%), none of whom received ATG as a conditioning regimen. Variables influencing EFS were chronic GVHD, marrow blasts before transplantation, and the WHO criteria. The present study clarifies the benefits of the fludarabine/Busulfex-based conditioning regimen for de novo MDS diagnosed according to the WHO criteria and shows that chronic GVHD appears to have a beneficial effect on survival rates, which are strongly associated with graft-versus-tumor effects.

Key words

Antithymocyte globulin Busulfex Chronic GVHD De novo MDS Fludarabine Reduced-intensity conditioning 

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Copyright information

© The Japanese Society of Hematology 2007

Authors and Affiliations

  • Byung-Sik Cho
    • 1
  • Yoo-Jin Kim
    • 1
  • Seok-Goo Cho
    • 1
  • Sung-Yong Kim
    • 1
  • Ki-Seong Eom
    • 1
  • Hee-Je Kim
    • 1
  • Seok Lee
    • 1
  • Chang-Ki Min
    • 1
  • Dong-Wook Kim
    • 1
  • Jong-Wook Lee
    • 1
  • Woo-Sung Min
    • 1
  • Chun-Choo Kim
    • 1
  1. 1.Catholic Hematopoietic Stem Cell Transplantation CenterThe Catholic University of KoreaSeoulKorea

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