Older Patients With MDS Achieve Similar Outcomes After Multiple Transplant Strategies

Submitted by onc_editor on Sun, 01/28/2018 - 16:47

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

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