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


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


Sources

1. Greenberg PL, Cox C, LeBeau M, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1998;89(6):2079–2088.

2. Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood 2012;120(12):2454–2465.

3. Kafková A, Tóthová E. Liečba myelodysplastického syndrómu. Onkológia (Bratisl.) 2014; 9(4):231–236.

4. Malcovati L, Hellström-Lindberg E, Bowen D, et al. Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendation from the European LeukemiaNet. Blood 2013;122(17):2943–2958.

5. Cutler CS, Lee SJ, Greenberg P, et al. A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. Blood 2004;104(2):579–585.

6. Saber W, Cutler CS, Nakamura R, et al. Impact of donor source on hematopoietic cell transplantation outcomes for patients with myelodysplastic syndromes (MDS). Blood 2013;122:1974–1982.

7. de Witte T, Suciu S, Verhoef G, et al. Intensive chemotherapy followed by allogeneic or autologous stem cell transplantation for patients with myelodysplastic syndromes (MDSs) and acute myeloid leukemia following MDS. Blood 2001;98(8):2326–2331.

8. Sierra J, Perez WS, Rozman C, et al. Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia. Blood 2002;100(6):1997–2004.

9. Warlick E, Cioc A, Defor T, et al. Allogeneic stem cell transplantation for adults with myelodysplastic syndromes: importance of pretransplant disease burden. Biol Blood Marrow Transplant 2009;15(1):30–38.

10. Yakoub-Agha I, Mesnil F, Kuentz M, et al. French Society of Bone Marrow Transplantation and Cell Therapy. Allogeneic marrow stem-cell transplantation from human leukocyte antigenidentical siblings versus human leukocyte antigen-allelic-matched unrelated donors (10/10) in patients with standard-risk hematologic malignancy: a prospective study from the French Society of Bone Marrow Transplantation and Cell Therapy. J Clin Oncol 2006;24(36):5695–5702.

11. Pullarkat V. Objectives of iron chelation therapy in myelodysplastic syndromes: more than meets the eye? Blood 2009;114(26):5251–5255.

12. Bulen JJ, Rogers HJ, Spalding PB, et al. Natural resistance, iron and infection: a challenge for clinical medicine. J Med Microbiol 2006;55(3):251–258.

13. Armand P, Kim HT, Cutler CS, et al. Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation. Blood 2007;109(10):4586–4588.

14. Sanchez CG, Quin Q, Sun K, et al. Infections in patients with myelodysplastic syndrome. Looking for the escape clause! Blood 2017;130(1):1694–1706.

15. Parker J, Shafi T, Pagliuca A, et al. Allogeneic stem cell transplantation in the myelodysplastic syndromes: interim results of outcome following reduced-intensity conditioning compared with standard preparative regimens. Br J Haematol 2002;119(1):144–154.

16. Al Ali HK, Brand R, van Biezen A, et al. A retrospective comparison of autologous and unrelated donor hematopoietic cell transplantation in myelodysplastic syndrome and secondary acute myeloid leukemia: a report on behalf of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Leukemia 2007;21:1945–1951.

17. Fenaux P, Haase D, Sanz G, et al. Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25(Suppl 3):iii57–iii69.

Labels
Haematology Internal medicine Clinical oncology

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Transfusion and Haematology Today

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2019 Issue 2

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