Outcome of stem cell transplant for myelodysplastic syndrome unaffected by age

NEW YORK (Reuters Health) - Allogeneic hematopoietic stem-cell transplantation should be considered for patients 50 years or older with myelodysplastic syndrome (MDS) or secondary acute myeloid leukemia, according to a December 14th online publication in the Journal of Clinical Oncology.

"Myelodysplastic syndromes...predominantly affect the elderly," lead author Dr. ZiYi Lim told Reuters Health by email. "Although treatment options are limited, many physicians are reluctant to consider these patients for transplantation."

"With the advances in transplantation over the last decade," he added, "this study demonstrates that in patients with myelodysplastic syndromes, age per se is no longer a barrier for transplantation, and there are a select proportion of older patients with MDS who may be cured with allogeneic hematopoietic stem cell transplantation."

Dr. Lim of Kings College Hospital, London, and colleagues reviewed data on 1,333 MDS patients who received transplants at a median age of 56 years. Most were between 50 and 60 years of age (n=884; 66%); 449 (34%) were older than 60.

The transplants were from HLA-matched siblings in 811 cases (61%) and from unrelated donors in the remaining 522. Five hundred patients (38%) had standard myeloablative conditioning; the others had reduced intensity conditioning.

The estimated overall 4-year survival was 31%. For patients between 50 and 60 years old, 4-year survival was 34% and for older patients, it was 27%.

On multivariate analysis, a significantly increased relapse rate at 4 years was associated with advanced disease stage at transplantation (hazard ratio, 1.51) and the use of reduced intensity conditioning (HR, 1.44).

Variables independently associated with mortality without relapse included advanced disease stage at transplantation (HR, 1.43), reduced intensity conditioning (HR, 0.79), and transplant from an unrelated donor.

According to the authors, the major independent variable significantly associated with an inferior 4-year overall survival was advanced disease stage at transplantation (hazard ratio 1.55; p <0.01).

Dr. Lim added: "We hope that the findings from this study will encourage more hematologists to consider allogeneic stem cell transplantation as a potentially curative treatment for their older MDS patients."

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