Long-Term Outcomes of Alemtuzumab-Based Reduced-Intensity Conditioned Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndrome and Acute Myelogenous Leukemia Secondary to Myelodysplastic Syndrome

Victoria T. Potter, Pramila Krishnamurthy, Linda D. Barber, ZiYi Lim, Michelle Kenyon, Robin M. Ireland, Hugues de Lavallade, Abdel Dhouri, Judith C.W. Marsh, Robert Marcus, Stephen Devereux, Aloysius Ho, Tony Pagliuca, Ghulam J. Mufti*

*Corresponding author for this work

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21 Citations (Scopus)
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Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a potential cure for patients with myelodysplastic syndrome (MDS) who are ineligible for standard-intensity regimens. Previously published data from our institution suggest excellent outcomes at 1 yr using a uniform fludarabine, busulfan, and alemtuzumab-based regimen. Here we report long-term follow-up of 192 patients with MDS and acute myelogenous leukemia (AML) secondary to MDS (MDS-AML) transplanted with this protocol, using sibling (n = 45) or matched unrelated (n = 147) donors. The median age of the cohort was 57 yr (range, 21 to 72 yr), and median follow-up was 4.5 yr (range, 0.1 to 10.6 yr). The 5-yr overall survival (OS), event-free survival, and nonrelapse mortality were 44%, 33%, and 26% respectively. The incidence of de novo chronic graft-versus-host disease (GVHD) was low at 19%, illustrating the efficacy of alemtuzumab for GVHD prophylaxis. Conversely, the 5-yr relapse rate was 51%. For younger patients (age 60 yr having a 5-yr OS of 15% and relapse rate of 66%. Patients receiving preemptive donor lymphocyte infusions had an impressive 5-yr OS of 67%, suggesting that this protocol may lend itself to the incorporation of immunotherapeutic strategies. Overall, these data demonstrate good 5-yr OS for patients with MDS and MDS-AML undergoing alemtuzumab-based RIC-HSCT. The low rate of chronic GVHD is encouraging, and comparative studies with other RIC protocols are warranted. 

Original languageEnglish
Pages (from-to)111-117
Number of pages7
JournalBIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume20
Issue number1
Early online date8 Nov 2013
DOIs
Publication statusPublished - Jan 2014

Keywords

  • Acute myelogenous leukemia
  • Myelodysplastic syndrome
  • Reduced intensity
  • Transplantatiom
  • Alemtuzumab
  • ACUTE MYELOID-LEUKEMIA
  • BONE-MARROW-TRANSPLANTATION
  • VERSUS-HOST-DISEASE
  • IMMUNE RECONSTITUTION
  • UNRELATED DONORS
  • ADULT PATIENTS
  • SURVIVAL
  • REGIMENS
  • AGE
  • REMISSIONS

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