Younger and older patients with myelodysplastic syndromes (MDS) have similar outcomes with allogeneic hematopoietic transplantation (HCT). However, older patients are less often offered early HCT than younger patients.

High-risk MDS patients with an HLA-matched donor who are candidates for reduced intensity conditioning (RIC) HCT have a significant overall survival (OS) advantage over patients who do not have a donor, according to research presented at the Transplantation and Cellular Therapy Meetings.

The researchers sought to determine whether RIC allogeneic HCT provides an overall survival benefit compared to non-transplant therapies. The authors performed an intent-to-treat analysis of 384 patients aged 50 to 75 with higher-risk MDS who were candidates for RIC HCT. The analysis compared outcomes of patients with matched donors to those with no donor who received standard therapy.

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The adjusted 3-year OS was 47.9% for patients in the donor arm and 26.6% for patients in the no donor arm (P =.0001). The donor arm had greater leukemia-free survival (LFS) at 3 years (35.8% vs 20.6%, P =.003).

The trial had a noncompliance rate of 26.3%. In an as-treated analysis, patients who underwent HCT had a greater 3-year OS than those who did not (47.4% vs 16%, P <.0001). Patients who underwent HCT also had a benefit in LFS (39.3% vs 10.9%, P <.0001).

The study authors strongly recommended that older adults with high-risk MDS be referred to a transplant center early.

Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Nakamura R, Saber W, Martens M, et al. A multi-center biologic assignment trial comparing reduced intensity allogeneic hematopoietic cell transplantation to hypomethylating therapy or best supportive care in patients aged 50-75 with advanced myelodysplastic syndrome: blood and marrow transplant clinical trials network study 1102 [TCT Meetings Abstract 3]. Transplant Cell Ther. 2021;27:S2-S3.