Yazarlar : Gerds AT, Gooley TA, Estey EH, Appelbaum FR, Deeg HJ, Scott BL.

Yayın : Biol Blood Marrow Transplant.

Yayın Yılı : 2012

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22252125

Konu : MDS

Literatür İçeriği :  

Abstract

While allogeneic hematopoietic cell transplantation (HCT) has proven curative potential for myelodysplastic syndrome (MDS), relapse after HCT remains a problem. Pre-transplant cytoreduction with induction chemotherapy (IC) has been utilized to reduce relapse rates, but is associated with significant toxicity and mortality. Hypomethylating agents may achieve cytoreduction with limited toxicity; however, data on the effect of pre-HCT hypomethylation on post-HCT outcomes are limited. We retrospectively reviewed results in 68 patients who underwent allogeneic HCT for MDS or acute myeloid leukemia (AML) transformed from MDS. Thirty-five patients had received cytoreduction with azacitidine prior to HCT with either a high-dose (40%) or a reduced-intensity (60%) conditioning regimen, and 33 had undergone IC prior to HCT with high-dose conditioning. The estimated one-year overall survival was 57% in the azacitidine group and 36% in the IC group. The risk of post-HCT mortality (HR 0.68, 95% CI 0.35-1.30), non-relapse mortality (HR 0.99, 95% CI 0.41-2.34), and relapse (HR 0.34, 95% CI 0.41-2.34) were lower in the azacitidine group compared to the IC group, but only the hazard for relapse was significantly lower. After adjustment for cytogenetic risk, IPSS, and donor, the rates of post-HCT relapse for the two cohorts were similar. While the current study was retrospective and non-randomized and needs to be interpreted in this context, the results add to the growing evidence that pre-HCT therapy with azacitidine is associated with less toxicity than IC, and may allow for similar post-HCT outcomes.

Literatür Arşivi