Effect of intensive chemotherapy or hypomethylation agent treatment before allogeneic hematopoietic stem cell transplantation on myelodysplastic syndrome patients / 中华器官移植杂志

ABSTRACT

Objective:To evaluate the outcomes and prognostic factors of myelodysplasia syndrome with excess blasts (MDS-EB) patients on intensive chemotherapy or hypomethylating agent treatment prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods:A total of 108 MDS-EB patients undergoing allo-HSCT from April 2015 to September 2019 were collected retrospectively, intensive chemotherapy or hypomethylating agent treatment (IC/HAM) group, n=72; support care (SC) group, n=36. Clinical outcomes and prognostic risk factors were analyzed. Results:Intensive chemotherapy or hypomethylating agent treatment pre-HSCT had no effects on overall survival (OS) ( P=0.725), relapse-free survival (RFS)( P=0.658), cumulative incidence rate (CIR) ( P=0.121) or non-relapse mortality (NRM)( P=0.236). Univariate and multivariate analysis of an entire cohort showed that poor cytogenetics was an independent risk factor for OS ( P=0.005), DFS ( P=0.001) and CIR( P=0.032); grade Ⅱ-Ⅳ acute graft venous host disease was independently correlated with unfavorable DFS( P=0.004). Conclusions:IC/HAM treatment pre-HSCT fails to yield discrepant post-HSCT outcomes in MDS-EB patients. The pooling of more patients in a well-designed multi-center clinical trial will further demonstrate the efficacy of treatment pre-HSCT in MDS-EB patients.