Haematopoietic stem cell transplantation in patients with myelodysplastic syndrome – a single centre experience

Czech version

Authors: L. Magyaricsová; S. Fliegová; D. Horváthová; J. Lukáš; M. Martišová; L. Sopko; E. Bojtárová; F. Farkaš; M. Mistrík; A. Bátorová
Authors‘ workplace: Klinika hematológie a transfuziológie Lekárskej fakulty Univerzity Komenského, Slovenskej zdravotníckej univerzity a Univerzitnej nemocnice Bratislava
Published in: Transfuze Hematol. dnes,25, 2019, No. 2, p. 168-175.
Category: Original Papers

Overview

Myelodysplastic syndromes (MDS) are a heterogeneous group of haematopoietic disorders characterized by peripheral blood cytopenias and increased risk of leukemic evolution. It is a disease of older patients whose advanced age and comorbidities often do not allow intensive or curative treatment. Before starting therapy, it is very important to evaluate not only disease-associated risks but also the patient´s state of health and performance status. The aim of this work was to identify MDS patient characteristics as well as factors that affect overall survival, engraftment and onset of infections. In our cohort of 44 patients who were diagnosed and underwent stem cell transplantation (SCT) at the Department of Haematology and Transfusion Medicine LFUK, SZU and UN Bratislava between November 1992 and January 2016, the median age was 41 years, with a male majority. The MDS RAEB II subtype predominated (15 cases), followed by RAEB I (14), RCMD (7) and MDS RA (8). Patients were mostly transplanted using matched unrelated donor (33 vs. 11). Peripheral stem cells were used in 42 cases and blood marrow was used in 2 cases. Nine patients underwent reduced intensity conditioning. Acute graft versus host disease (GvHD) appeared in 20 cases, chronic GvHD in 9. In our cohort, we demonstrated a statistically relevant association between a rising level of ferritin and onset of infection (p = 0.0000038). We tried to identify factors that affect overall survival and we found that advanced disease (p = 0.0195), more days to transplantation (p = 0.006), more than 10% blasts in the bone marrow (p = 0.0107) and a rising level of ferritin (p = 0.0057) statistically influence overall survival. Platelet counts > 20 x 10⁹/l and neutrophil counts > 0.5 x 10⁹/l were attained on day +11,5 and 13,3 resp. by patients after reduced intensity conditioning, while patients after myeloablative conditioning achieved these counts on day +14,3 and 16,6 resp. (p = 0.00962, p = 0.00775). Patients transplanted using a sibling donor had a statistically shorter stay in hospital than those with a matched unrelated donor (p = 0.0002). As myelodysplastic syndrome is a disease of older age, we can expect an increase in the number of cases as the population ages. Despite progress in the treatment of MDS and SCT remains the only treatment with a potentially curative effect. It is very important to continue in research of pathogenesis of MDS and remains a major future challenge.

Keywords:

myelodysplastic syndromes – haematopoietic stem cell transplantation – overall survival – infectious complications

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