Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia

ZiYi Lim; Ronald Brand; Rodrigo Martino; Anja van Biezen; Juergen Finke; Andrea Bacigalupo; Dietrich Beelen; Agnes Devergie; Emilio Alessandrino; Roel Willemze; Tapani Ruutu; Marc Boogaerts; Michele Falda; Jean-Pierre Jouet; Dietger Niederwieser; Nicolaus Kroger; Ghulam J. Mufti; Theo M. De Witte

doi:10.1200/JCO.2009.21.8073

Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia

ZiYi Lim, Ronald Brand, Rodrigo Martino, Anja van Biezen, Juergen Finke, Andrea Bacigalupo, Dietrich Beelen, Agnes Devergie, Emilio Alessandrino, Roel Willemze, Tapani Ruutu, Marc Boogaerts, Michele Falda, Jean-Pierre Jouet, Dietger Niederwieser, Nicolaus Kroger, Ghulam J. Mufti, Theo M. De Witte

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Abstract

Purpose This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients. Patients and Methods We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC). Results The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P <.01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P <.01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P <.01) was the major independent variable associated with an inferior 4-year overall survival. Conclusion Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.

Original language	English
Pages (from-to)	405 - 411
Number of pages	7
Journal	Journal of Clinical Oncology
Volume	28
Issue number	3
DOIs	https://doi.org/10.1200/JCO.2009.21.8073
Publication status	Published - 20 Jan 2010

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10.1200/JCO.2009.21.8073

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Lim, Z., Brand, R., Martino, R., van Biezen, A., Finke, J., Bacigalupo, A., Beelen, D., Devergie, A., Alessandrino, E., Willemze, R., Ruutu, T., Boogaerts, M., Falda, M., Jouet, J.-P., Niederwieser, D., Kroger, N., Mufti, G. J., & De Witte, T. M. (2010). Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia. Journal of Clinical Oncology, 28(3), 405 - 411. https://doi.org/10.1200/JCO.2009.21.8073

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title = "Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia",

abstract = "Purpose This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients. Patients and Methods We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC). Results The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P <.01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P <.01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P <.01) was the major independent variable associated with an inferior 4-year overall survival. Conclusion Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.",

author = "ZiYi Lim and Ronald Brand and Rodrigo Martino and {van Biezen}, Anja and Juergen Finke and Andrea Bacigalupo and Dietrich Beelen and Agnes Devergie and Emilio Alessandrino and Roel Willemze and Tapani Ruutu and Marc Boogaerts and Michele Falda and Jean-Pierre Jouet and Dietger Niederwieser and Nicolaus Kroger and Mufti, {Ghulam J.} and {De Witte}, {Theo M.}",

year = "2010",

month = jan,

day = "20",

doi = "10.1200/JCO.2009.21.8073",

language = "English",

volume = "28",

pages = "405 -- 411",

journal = "Journal of Clinical Oncology",

issn = "1527-7755",

publisher = "American Society of Clinical Oncology",

number = "3",

}

Lim, Z, Brand, R, Martino, R, van Biezen, A, Finke, J, Bacigalupo, A, Beelen, D, Devergie, A, Alessandrino, E, Willemze, R, Ruutu, T, Boogaerts, M, Falda, M, Jouet, J-P, Niederwieser, D, Kroger, N, Mufti, GJ & De Witte, TM 2010, 'Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia', Journal of Clinical Oncology, vol. 28, no. 3, pp. 405 - 411. https://doi.org/10.1200/JCO.2009.21.8073

TY - JOUR

T1 - Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia

AU - Lim, ZiYi

AU - Brand, Ronald

AU - Martino, Rodrigo

AU - van Biezen, Anja

AU - Finke, Juergen

AU - Bacigalupo, Andrea

AU - Beelen, Dietrich

AU - Devergie, Agnes

AU - Alessandrino, Emilio

AU - Willemze, Roel

AU - Ruutu, Tapani

AU - Boogaerts, Marc

AU - Falda, Michele

AU - Jouet, Jean-Pierre

AU - Niederwieser, Dietger

AU - Kroger, Nicolaus

AU - Mufti, Ghulam J.

AU - De Witte, Theo M.

PY - 2010/1/20

Y1 - 2010/1/20

N2 - Purpose This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients. Patients and Methods We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC). Results The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P <.01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P <.01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P <.01) was the major independent variable associated with an inferior 4-year overall survival. Conclusion Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.

AB - Purpose This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients. Patients and Methods We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC). Results The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P <.01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P <.01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P <.01) was the major independent variable associated with an inferior 4-year overall survival. Conclusion Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.

U2 - 10.1200/JCO.2009.21.8073

DO - 10.1200/JCO.2009.21.8073

M3 - Article

SN - 1527-7755

VL - 28

SP - 405

EP - 411

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 3

ER -

Allogeneic Hematopoietic Stem-Cell Transplantation for Patients 50 Years or Older With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia

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