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

Outcome after relapse of myelodysplastic syndrome and secondary acute myeloid leukemia after allogeneic stem cell transplantation: a retrospective registry analysis on 698 patients by the Chronic Malignancies Working Party of European Society of Blood and Marrow Transplantation.
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Schmid C, de Wreede LC, van Biezen A, Finke J, Ehninger G, Ganser A, Volin L, Niederwieser D, Beelen D, Alessandrino P, Kanz L, Schleuning M, Passweg J, Veelken H, Maertens J, Cornelissen JJ, Blaise D, Gramatzki M, Milpied N, Yakub-Agha I, Mufti G, Rovira M, Arnold R, De Witte T, Robin M, Kröger N,


Schmid C, de Wreede LC, van Biezen A, Finke J, Ehninger G, Ganser A, Volin L, Niederwieser D, Beelen D, Alessandrino P, Kanz L, Schleuning M, Passweg J, Veelken H, Maertens J, Cornelissen JJ, Blaise D, Gramatzki M, Milpied N, Yakub-Agha I, Mufti G, Rovira M, Arnold R, De Witte T, Robin M, Kröger N, (click to view)

Schmid C, de Wreede LC, van Biezen A, Finke J, Ehninger G, Ganser A, Volin L, Niederwieser D, Beelen D, Alessandrino P, Kanz L, Schleuning M, Passweg J, Veelken H, Maertens J, Cornelissen JJ, Blaise D, Gramatzki M, Milpied N, Yakub-Agha I, Mufti G, Rovira M, Arnold R, De Witte T, Robin M, Kröger N,

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Haematologica 2017 11 03() pii haematol.2017.168716
Abstract

No standard exists for the treatment of myelodysplastic syndrome relapsing after allogeneic stem cell transplantation. We performed a retrospective registry analysis of outcome and risk factors in 698 patients, treated with different strategies. Median overall survival from relapse was 4.7 months (4.1-5.3), 2-year survival was 17.7% (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 either had received no cellular treatment, (i.e. palliative chemotherapy or best supportive care, n=375), donor lymphocyte infusion (n=213), or second transplant (n=110). Treatment groups were analyzed separately because of imbalanced characteristics and difficulties to retrospectively evaluate the reason for individual treatments. Among patients receiving no cellular therapy, 109 were alive at 6 months from relapse, achieving a median overall survival from this landmark of 8.9 (5.1-12.6) months. Two-year survival was 29.7%. Recipients of donor lymphocytes achieved a median survival from first infusion of 6.0 (3.7-8.3) months with 2-year survival 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 transplantation, median survival from second transplant was 4.2 months (2.5-5.9), 2-year survival 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 allow to identify patients benefitting from donor lymphocyte infusion and second transplantation, and may serve as baseline for prospective trials.

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