CM-06. Timing of allogeneic hematopoietic stem cell transplantation in patients with high risk myelodysplastic syndrome
Nikolai Yu. Tcvetkov, Ivan S. Moiseev, Maria V. Barabanshikova, Kseniia S. Iurovskaia, Zarema K. Abdulkhalikova, Yulia Yu. Vlasova, Alexander D. Kulagin, Elena V. Morozova
RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
Correspondence:
Dr. Nikolai Yu. Tcvetkov, phone+7(911) 233-48-77, e-mail: nikolai.tcvetkov@yandex.ru
Summary
We analyzed cohort of 115 patients with myelodysplastic syndrome (MDS) treated in our center. All patients were high/very high risk according to IPSS-R. The median age was 46 years (18-75). Allogeneic hematopoietic stem cell transplantation (HSCT) was performed for 63 patients. Median follow-up period was 598 days (22-3651).
At landmark point of 180 days, 108 patients of the general group were included in the analysis.
Results
The patients who underwent HSCT within 180 days of diagnosis had a significantly greater 2-year progression-free survival compared with those who did not undergo HSCT during this period: 63.4% (n=62, 95%CI: 49.8-74.2, median not reached) versus 26.2% (n=6, 95%CI: 14.1-40, median 12.5 months), p<0.001. In multivariate analysis, the fact of performing HSCT preserved a significant effect on 2-year progression-free survival (HR 0.38, 95%CI: 0.2-0.72, p=0.003). At landmark point of 365 days, 86 patients of the general group were included in the analysis. Patients who underwent HSCT within 365 days from the moment of diagnosis had a significantly greater 2-year progression-free survival compared with those who did not undergo HSCT during this period: 70% (n=55, 95%CI: 55.8-80.5, median not reached) versus 38.8% (n=31, 95%CI: 21.1-56.2, median 19.5 months), p=0.003. In multivariate analysis, the fact of performing HSCT preserved a significant effect on 2-year progression-free survival (HR 0.41, 95%CI: 0.18-0.92, p=0.03). At landmark point of 545 days, we did not find a statistically significant difference in 2-year progression-free survival between patients who underwent HSCT within 545 days of diagnosis (n=45) and those who did not (n=17).
Conclusions
Allogeneic HSCT in patients with high risk MDS should be performed as soon as possible after diagnosis. In the high/very high risk group and in cases of secondary MDS induction therapy does not lead to remission, in these cases upfront HSCT may be considered. Currently, low dose therapy in this group is considered as a deterrent measure during the donor search. Optimal period to perform HSCT is 0.5-1 year after the diagnosis, beyond this period HSCT offers no benefit due to high incidence of MDS progression.
Acknowledgment
This work was supported by Russian Science Foundation, grant № 17-75-20145-П.
Keywords
Myelodysplastic syndrome, allogeneic hematopoietic stem cell transplantation.