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Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation: a retrospective registry analysis on 698 patients by the Chronic Malignancies Working Party of the European Society of Blood and Marrow Transplantation

Christoph Schmid 1 Liesbeth C. Wreede Anja Biezen Juergen Finke Gerhard Ehninger 2 Arnold Ganser 3 Liisa Volin 4 Dietger Niederwieser 5 Dietrich Beelen 6, 7 Paolo Alessandrino Lothar Kanz 8 Michael Schleuning Jakob Passweg 9 Hendrik Veelken 10 Johan Maertens 11 Jan J. Cornelissen 12 Didier Blaise 13, 14 Martin Gramatzki 15 Noel Milpied 16 Ibrahim Yakoub-Agha 17, 18 Ghulam Mufti 19 Montserrat Rovira 20, 21 Renate Arnold 22 Theo Witte Marie Robin 23 Nikolaus Kroeger
Abstract : No standard exists for the treatment of myelodysplastic syndrome relapsing after allogeneic stem cell transplantation. We performed a retrospective registry analysis of outcomes and risk factors in 698 patients, treated with different strategies. The median overall survival from relapse was 4.7 months (95% confidence interval: 4.1-5.3) and the 2-year survival rate was 17.7% (95% confidence interval: 14.8-21.2%). Shorter remission after transplantation (P<0.001), advanced disease (P=0.001), older age (P=0.007), unrelated donor (P=0.008) and acute graft-versus-host disease before relapse (P<0.001) adversely influenced survival. At 6 months from relapse, patients had received no cellular treatment, (i.e. palliative chemotherapy or best supportive care, n=375), donor lymphocyte infusion (n=213), or a second transplant (n=110). Treatment groups were analyzed separately because of imbalanced characteristics and difficulties in retrospectively evaluating the reason for individual treatments. Of the patients who did not receive any cellular therapy, 109 were alive at 6 months after relapse, achieving a median overall survival from this landmark of 8.9 months (95% confidence interval: 5.1-12.6). Their 2-year survival rate was 29.7%. Recipients of donor lymphocytes achieved a median survival from first infusion of 6.0 months (95% confidence interval: 3.7-8.3) with a 2-year survival rate of 27.6%. Longer remission after first transplantation (P<0.001) and younger age (P=0.009) predicted better outcome. Among recipients of a second transplant, the median survival from second transplantation was 4.2 months (95% confidence interval: 2.5-5.9), and their 2-year survival rate was 17.0%. Longer remission after first transplantation (P<0.001), complete remission at second transplant (P=0.008), no prior chronic graft-versus-host disease (P<0.001) and change to a new donor (P=0.04) predicted better outcome. The data enabled identification of patients benefiting from donor lymphocyte infusion and second transplantation, and may serve as a baseline for prospective trials.
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Submitted on : Wednesday, May 29, 2019 - 2:46:44 PM
Last modification on : Wednesday, August 19, 2020 - 11:17:53 AM

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Christoph Schmid, Liesbeth C. Wreede, Anja Biezen, Juergen Finke, Gerhard Ehninger, et al.. Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia following allogeneic stem cell transplantation: a retrospective registry analysis on 698 patients by the Chronic Malignancies Working Party of the European Society of Blood and Marrow Transplantation. Haematologica, 2018, 103 (2), pp.237-245. ⟨10.3324/haematol.2017.168716⟩. ⟨hal-02143541⟩

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