Objective: To investigate the clinical features and prognosis of patients with myelodysplastic syndrome (MDS) who received allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Methods: A total of 45 patients with MDS and transformed acute myeloid leukemia (tAML) who received allo-HSCT between January 2009 and December 2014 were enrolled in this study. The effects of different conditioning regimens, donor and chemotherapy before transplantation on the clinical outcome were analyzed retrospectively.
Results: The median follow-up time for these patients was 54.6 months (ranged from 1 to 72.1 months), the 4-year cumulative overall survival (OS) and disease-free survival (DFS) rates were 77.1% and 62.1%, respectively. In myeloblative conditioning group and reduced intensity conditioning group, the 3-year cumulative OS rate was 69% and 68.6% (HR = 1.0, P = 0.984), respectively, the 3-year cumulative relapse rate was 17.6% and 33.3% (HR = 3.389, P = 0.162). The 100-day cumulative rate of aGVHD (38.6%) in HLA-identical nonsibling group was similar to HLA identical sibling group (37%) (HR = 1.089, P = 0.885); meanwhile the similar 3-year commulative OS rate was achieved in the 2 groups (72.7% and 70%) (HR = 0.952, P = 0.942). Among 26 patients with RAEB-2 and t-AML, the 2-year cumulative OS were 66.7% and 58.3% (HR = 1.265, P = 0.750) and 2-year cumulative relapse rates were 20.0% and 12.5% (HR = 0.417, P = 0.477) in non-chemotherapy and CR post-chemotherapy subgroups. The 1-year cumulative OS rate was 53.5% and 84.8% in the group with or without aGVHD. The patients with aGVHD had higher transplantation related mortality (TRM) compared with patients without aGVHD (HR = 15.0, P =0.011).
Conclusion: The reduced intensity conditioning doesn't reduce OS rate in patients with MDS, and elderly patients can benefit from it. The OS rate is similar between HLA-identical sibling and HLA-identical nonsibling allo-HSCT. The chemotherapy before transplantation cannot prolong the survival of MDS patients.