Comparison of Seq, MAC, and RIC for patients with higher risk MDS

Potter V, Gras L, Koster L, et al. Sequential vs Myeloblative vs Reduced Intensity Conditioning for Patients With Myelodysplastic Syndromes With an Excess of Blasts at Time of Allogeneic Haematopoietic Cell Transplantation: A Retrospective Study by the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplantation. 2023; (doi: 10.1038/s41409-023-02111-3).

Outcomes after allogeneic hematopoietic stem cell transplantation (allo-HCT) in patients with higher-risk myelodysplastic syndromes (MDS) are dictated primarily by baseline disease risk and individual characteristics, with choice of conditioning protocol having little impact, an analysis found. Investigators examined data from a sample of 303 MDS patients who had an excess of blasts at the time of allo-HCT, qualifying them as high risk. Among them, 105 underwent sequential (Seq) conditioning — chemotherapy followed quickly by transplant conditioning — which researchers suspected might relieve disease burden and improve outcomes. A total of 158 patients received reduced intensity conditioning, and the remaining 40 underwent myeloablative conditioning. Across the cohort, 3-year overall survival was 50% and relapse-free survival was 45%, but researchers calculated no significant difference in either metric when patients were stratified according to conditioning protocol. While Seq did not improve allo-HCT outcomes in this high-risk sample of MDS patients, the study authors report several factors that worsened outcomes — including sibling donor, ≥20% blasts at the time of allo-HCT, lower performance status, and worse IPSS-R cytogenetics.

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Tags: AlloHCT, allogeneic transplantation, HCT, MDS, Survival, Allo-HCT, allogeneic HCT, all-HCT, allogeneic stem cell transplantation, survival rate