ABSTRACT
BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only treatment with a curative potential for myelodysplastic syndrome (MDS) patients. Allo-HSCT has substantial risks, particularly in the elderly, and its role for older MDS patients has yet to be defined. METHODS: We analyzed 88 MDS patients aged ≥ 60 years with allo-HSCT after reduced intensity conditioning regimens over the last decade. The study cohort had high risk features; 47 of 88 (53.4%) patients were > 65 years of age, 24 (27%) patients had cytogenetic abnormalities consistent with monosomal karyotype (MKpos), 33 (38%) patients had histological subtype of RAEB-1 and RAEB-2 at diagnosis, and 45 (51%) patients had a hematopoietic cell transplantation-comorbidity index (HCT-CI) of ≥ 3. RESULTS: The 3-year incidence of progression, transplant-related mortality (TRM), and overall survival (OS) were 26% (95% confidence interval [CI], 18%-37%), 35% (95% CI, 26%-47%), and 41% (95% CI, 30%-52%), respectively. MKpos was the only prognostic factor that increased the risk of disease progression compared with good-risk cytogenetics (hazard ratio [HR] = 9.5, P = .003) as well as MKneg (HR = 3.3, P = .01). For TRM, HCT-CI ≥ 3, but not age >65 years, was associated with worse outcomes (HR = 3.1, P = .007). Cytogenetics and HCT-CI enabled us to identify prognostic groups for OS. MKpos patients had the worst 3-year OS (17%), whereas patients with good-risk cytogenetics and HCT-CI < 3 had the best OS (92%). CONCLUSION: Our results confirm that allo-HSCT can provide long-term survival in older MDS patients. Cytogenetics and HCT-CI identify prognostic risk groups and guide selection of older MDS patients who are candidates for allo-HSCT. Cancer 2017;123:2661-70. © 2017 American Cancer Society.
Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Myelodysplastic Syndromes/therapy , Transplantation Conditioning/methods , Transplantation, Homologous/methods , Aged , Anemia, Refractory, with Excess of Blasts/epidemiology , Anemia, Refractory, with Excess of Blasts/genetics , Anemia, Refractory, with Excess of Blasts/therapy , Cause of Death , Chromosome Aberrations , Comorbidity , Disease Progression , Female , Graft vs Host Disease/epidemiology , Humans , Leukemia, Myelomonocytic, Chronic/epidemiology , Leukemia, Myelomonocytic, Chronic/genetics , Leukemia, Myelomonocytic, Chronic/therapy , Male , Middle Aged , Monosomy/genetics , Myelodysplastic Syndromes/classification , Myelodysplastic Syndromes/epidemiology , Myelodysplastic Syndromes/genetics , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
There is limited data on the outcomes of autologous hematopoietic cell transplantation (auto-HCT) in myeloma patients, 75 or older. We retrospectively analyzed all myeloma patients (n = 72), aged ≥75, who underwent auto-HCT at our center between January 1, 2000, and December 31, 2015. All patients received melphalan ≥140 mg m-2 conditioning. At day-100, the cumulative incidence of non-relapse mortality was 1%. The overall response rate was 91% with 29% achieving complete/stringent complete remission. The median progression-free survival (PFS) was 31.4 months, and median overall survival (OS) was 72.8 months. The presence of high-risk cytogenetic abnormalities was associated with inferior PFS (p = 0.005) and OS (p = 0.005), while international staging system stage III was identified as a negative prognostic factor for OS (p = 0.002 vs. stage II). We conclude that auto-HCT can be safely performed in myeloma patients 75 and older and is associated with encouraging response rates.