A retrospective analysis has suggested there are differences in patient outcomes based on the conditioning regimen used with allogeneic hematopoietic stem cell transplantation (HSCT) in treatment of myelodysplastic syndromes (MDS). Results of the analysis were published in the American Journal of Hematology.

In this study, reduced-intensity conditioning (RIC) was compared with nonmyeloablative (NMA) conditioning for HSCT in 151 patients with MDS or MDS/myeloproliferative neoplasms. Patients included in this study were 50 years of age or older. Analyses were conducted both for the whole population and for patients stratified by age at the time of HSCT, with a cutoff of 65 years.

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NMA conditioning occurred more often in older patients compared with RIC, but for patients younger than 65 years, there was no significant difference in usage of either method. In the overall population, aggressiveness of disease also showed no significant association with the use of either conditioning strategy.

In the total population, outcomes of overall survival, nonrelapse mortality, and cumulative incidence of relapse were similar for both conditioning regimens.

Cumulative incidence of relapse did not differ by conditioning method for younger patients. However, for younger patients receiving NMA conditioning, nonrelapse mortality was significantly increased (P =.03), and the trend for overall survival was marginally shorter (P =.06) compared with outcomes for younger patients receiving RIC.

Overall, acute graft-versus-host disease did not differ by conditioning regimen (P =.59), but chronic graft-versus-host disease (P =.01) and graft rejection (P =.02) were both more common with NMA conditioning.

“Altogether, our results indicate that NMA conditioning can result in similar disease control in patients [with MDS compared with] RIC conditioning, but especially that patients under 65 years of age [who are] eligible for both conditioning regimens may benefit from RIC-HSCT,” the authors concluded. They recommended prospective clinical trials to determine the best conditioning strategy for the older patient population.

Reference

  1. Jentzsch M, Döhring C, Linke R, et al. Comparison of non-myeloablative and reduced-intensity allogeneic stem cell transplantation in older patients with myelodysplastic syndromes [published online September 8, 2019]. Am J Hematol. doi:10.1002/ajh.25636