A retrospective comparison of autologous and unrelated donor hematopoietic cell transplantation in myelodysplastic syndrome and secondary acute myeloid leukemia: a report on behalf of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

• Published in: Leukemia Vol. 21; no. 9; pp. 1945 - 1951
• Main Authors: AL-ALI, H. K, BRAND, R, NIEDERWIESER, D, DE WITTE, T, VAN BIEZEN, A, FINKE, J, BOOGAERTS, M, FAUSER, A. A, EGELER, M, CAHN, J.-Y, ARNOLD, R, BIERSACK, H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing 01.09.2007; Nature Publishing Group
• Subjects: Acute Disease; Acute myeloid leukemia; Adolescent; Adult; Age Distribution; Aged; Autografts; Biological and medical sciences; Care and treatment; Chemotherapy; Disease-Free Survival; Female; Health services; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - mortality; Hematopoietic stem cells; Humans; Incidence; Leukemia; Leukemia, Myeloid - mortality; Leukemia, Myeloid - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Mud; Myelodysplastic syndrome; Myelodysplastic syndromes; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; Patient outcomes; Patients; Recurrence; Remission; Retrospective Studies; Stem cell transplantation; Survival; Survival Analysis; Tissue Donors; Transplantation; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome; Tumors; Germany; Secondary; Hematology; European group for blood and marrow transplantation; Unrelated donor; Stem cell; Hematopoietic cell; Homograft; stem-cell transplantation; Malignant hemopathy; voluntary unrelated donors; Myelodysplastic syndrome; Retrospective; Chronic; secondary acute myeloid leukemia; Graft; Comparative study; Acute myelocytic leukemia
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2404774

Hematopoietic cell transplantation (HCT) is an effective treatment for myelodysplasia (MDS) and secondary acute myeloid leukemia (sAML). In this study, outcome of 593 patients with MDS/sAML after autologous and allogeneic HCT from a matched unrelated donor (MUD) were compared. A total of 167 (28%) patients received HCT from MUD without prior chemotherapy (MUD-U). The rest received HCT in first complete remission (CR1) (Autologous (Auto-CR1), n=290 (49%), HCT from MUD (MUD-CR1), n=136 (23%)). Survival at 3 years was best in MUD-CR1 (50%) compared to Auto-CR1 (41%) and MUD-U (40%) (P=0.01). Similarly, disease-free survival was 44% for MUD-CR1 compared to Auto-CR1 (28%) and MUD-U (34%) (P=0.03). Treatment-related mortality was 17% in Auto-CR1 compared to MUD-CR1 (38%) and MUD-U (49%) (P<0.001). Relapse for Auto-CR1 was 62% compared to 24 and 30% for MUD-CR1 and MUD-U, respectively (P<0.001). Outcome was best for patients with low tumor burden transplanted 6-12 months after diagnosis. Factors influencing outcome at 3 years were mainly significant in the first 6 months. Only, relapse after autologous HCT remained constant over time. Outcomes after allogeneic HCT in patients of 20-40 and >40 years were similar. Autologous and Allogeneic HCT from MUD offer the possibility of long-term survival to patients with MDS/sAML.