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Older Patients With MDS Achieve Similar Outcomes After Multiple Transplant Strategies

01/28/2018

Haplo/cord reduced-intensity allogeneic transplantation yields similar outcomes as HLA-matched unrelated donor cells (MUD) for older patients with myelodysplastic syndrome (MDS), according to a study published in Biology of Blood and Marrow Transplantation (online December 27, 2017; doi:10.1016/j.bbmt.2017.12.794).

Haplo/cord transplantation combines an umbilical cord blood graft with CD34-selected haploidentical cells. This transplantation method has shown to reduce hematopoietic recovery followed by durable umbilical cord blood engraftment.

Andrew S Artz, MD, department of medicine, University of Chicago, and colleagues conducted a study to compare outcomes of transplants in older patients (aged at least 50 years) with acute myeloid leukemia (AML) or high-risk MDS who received either HLA-matched MUD cells or haplo/cord reduced-intensity transplantation. A total of 109 patients were sampled who underwent reduced-intensity transplantation with fludarabine and melphalan and antibody-mediated T-cell depletion for AML (n = 83) or high-risk MDS (n = 26) followed by either MUD (n = 68) or haplo/cord (n = 41) graft between 2007 and 2013.

Researchers noted that patient characteristics were similar for each graft source, except for some patients receiving a haplo/cord transplant (P = .01). Additionally, 50% of the patients with AML were not in remission.

Results of the study showed that 2-year progression-free survival (PFS), overall survival (OS), and graft-versus-host disease-free relapse-free survival were 38%, 48% and 32.1% for patients receiving MUC, compared with 33%, 48%, and 33.8% for those receiving haplo/cord transplantation.

Furthermore, acute grade II-IV and chronic graft-versus-host-disease rates were comparable between the two transplant cohorts (19.5% and 4.9% in the haplo/cord transplant cohort vs 25% and 7.4% in the MUD cohort; P = .53 and P = .62, respectively).

A multivariate analysis confirmed no significant differences in transplant outcomes by donor type.

Findings from the study led Dr Artz and colleagues to conclude that haplo/cord reduced-intensity allogeneic transplantation may be a promising option for older patients with AML or MDS who do not have matched donors.—Zachary Bessette

To read about the risk of thrombosis in MPNs, click here

Furthermore, acute grade II-IV and chronic graft-versus-host-disease rates were comparable between the two transplant cohorts (19.5% and 4.9% in the haplo/cord transplant cohort vs 25% and 7.4% in the MUD cohort; P = .53 and P = .62, respectively).

To read about the risk of thrombosis in MPNs, click here

A multivariate analysis confirmed no significant differences in transplant outcomes by donor type.

Findings from the study led Dr Artz and colleagues to conclude that haplo/cord reduced-intensity allogeneic transplantation may be a promising option for older patients with AML or MDS who do not have matched donors.—Zachary Bessette