Efficacy and Safety of Allogeneic Hematopoietic Stem Cell Transplantation with Decitabine-containing Regimen in Myelodysplastic Syndromes and Myelodysplastic Syndromes Transformed Acute Myeloid Leukemia.
10.19746/j.cnki.issn.1009-2137.2023.02.031
- Author:
Yu-Xin WANG
1
,
2
;
Yao SUN
1
,
2
;
Jing XIE
1
,
2
;
Na LIU
1
,
2
;
Jiang-Wei HU
1
,
2
;
Zhuo-Qing QIAO
1
,
2
;
San-Chun LAN
1
,
2
;
Long ZHAO
1
,
3
;
Yang YANG
1
,
3
;
Yu-Hang LI
1
,
2
;
Bin ZHANG
1
,
3
;
Liang-Ding HU
1
,
4
Author Information
1. Senior Department of Hematology, The Fifth Medical Centre of Chinese People's Liberation Army General Hospital
2. Beijing 100071, China.
3. Beijing Key Laboratory of Stem Cell Therapy and Transformation Research, Beijing 100071, China.
4. Beijing 100071, China.E-mail: huliangding@sohu.com.
- Publication Type:Journal Article
- Keywords:
myelodysplastic syndrome;
allogeneic hematopoietic stem cell transplantation;
conditioning regimen;
decitabine
- MeSH:
Male;
Female;
Humans;
Decitabine;
Retrospective Studies;
Transplantation, Homologous/adverse effects*;
Transplantation Conditioning/adverse effects*;
Myelodysplastic Syndromes/complications*;
Leukemia, Myeloid, Acute/therapy*;
Hematopoietic Stem Cell Transplantation/adverse effects*;
Chronic Disease;
Graft vs Host Disease/therapy*;
Recurrence
- From:
Journal of Experimental Hematology
2023;31(2):522-531
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To evaluate the efficacy and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with decitabine (Dec)-conditioning regimen in the treatment of myelodysplastic syndrome (MDS) and MDS transformed acute myeloid leukemia (MDS-AML).
METHODS:The characteristics and efficacy data of 93 patients with MDS and MDS-AML who received allo-HSCT in our center from April 2013 to November 2021 were retrospectively analyzed. All patients were administered by myeloablative conditioning regimen containing Dec (25 mg/m2 /d×3 d).
RESULTS:Among the 93 patients, 63 males and 30 females, were diagnosed as MDS（n ＝77）, MDS-AML（n ＝16）. The incidence of I/II grade regimen-related toxicity (RRT) was 39.8%, and III grade RRT was only found in 1 patient (1%). Neutrophil engraftment was successful in 91 (97.8%) patients after a median neutrophil engraftment time of 14 (9-27) days; Successful platelet engraftment was achieved in 87 (93.5%) patients, with a median engraftment time of 18 (9-290) days. The incidence of acute graft versus host disease（aGVHD） and grade III-IV aGVHD was 44.2% and 16.2%, respectively. The incidence of chronic graft versus host disease（cGVHD） and moderate-to-severe cGVHD was 59.5% and 37.1%, respectively. Of the 93 patients, 54 (58%) developed posttransplant infections, among which lung infection (32.3%) and bloodstream infection (12.9%) were the most common. The median follow-up after transplantation was 45 (0.1-108) months. The 5-year overall survival (OS) rate, disease-free survival (DFS) rate, treatment-related mortality, and cumulative incidence of relapse were 72.7%, 68.4%, 25.1%, and 6.5%, respectively. And the 1-year graft-versus-host disease/relapse-free survival rate was 49.3%. The patients in different group of relative high-risk prognostic scoring or low-risk prognostic scoring, with or without poor-risk mutation(s), with mutations number ≥3 or <3 had similar 5-year OS rate (more than 70%). Multivariate analysis showed that the incidence of grade III-IV aGVHD was the independent risk factor affecting OS（P =0.008）and DFS (P =0.019).
CONCLUSION:Allo-HSCT with Dec-conditioning regimen is feasible and effective in the treatment of patients with MDS and MDS-AML, especially those in high prognostic risk and with poor-risk mutations.
