Fiche publication
Date publication
septembre 2014
Journal
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Auteurs
Membres identifiés du Cancéropôle Est :
Pr RUBIO Marie Thérèse
Tous les auteurs :
Damaj G, Mohty M, Robin M, Michallet M, Chevallier P, Beguin Y, Nguyen S, Bories P, Blaise D, Maillard N, Rubio MT, Fegueux N, Cornillon J, Clavert A, Huynh A, Adès L, Thiébaut-Bertrand A, Hermine O, Vigouroux S, Fenaux P, Duhamel A, Yakoub-Agha I
Lien Pubmed
Résumé
Cytoreduction before allogeneic stem cell transplantation (allo-SCT) for patients with myelodysplastic syndromes remains a debatable issue. After excluding patients who had received preconditioning induction chemotherapy, we analyzed 128 consecutive patients with myelodysplastic syndrome who received reduced-intensity or nonmyeloablative conditioning (RIC/NMA) allo-SCT. Among them, 40 received azacitidine (AZA) before transplant (AZA group) and 88 were transplanted up front (best supportive care [BSC] group). At diagnosis, 55 patients had intermediate 2 or high-risk scores per the International Prognostic Scoring System and 33 had a high cytogenetic risk score. Progression to a more advanced disease before allo-SCT was recorded in 22 patients. Source of stem cells were blood (n = 112) or marrow (n = 16) from sibling (n = 78) or HLA-matched unrelated (n = 50) donors. With a median follow-up of 60 months, 3-year overall survival, relapse-free survival, cumulative incidence of relapse, and nonrelapse mortality were, respectively, 53% versus 53% (P = .69), 37% versus 42% (P = .78), 35% versus 36% (P = .99), and 20% versus 23% (P = .74), for the AZA group and BSC group, respectively. Multivariate analysis confirmed the absence of statistical differences in outcome between the AZA and BSC groups, after adjusting for potential confounders using the propensity score approach. The absence of cytoreduction before RIC/NMA allo-SCT did not seem to alter the outcome. However, our results emphasize the need to perform prospective protocols to delineate the role of debulking strategy and to identify subsets of patients who may benefit from this approach.
Mots clés
Adult, Aged, Antimetabolites, Antineoplastic, therapeutic use, Azacitidine, therapeutic use, Female, Hematopoietic Stem Cell Transplantation, methods, Humans, Male, Middle Aged, Myelodysplastic Syndromes, mortality, Transplantation Conditioning, methods, Transplantation, Homologous, methods, Young Adult
Référence
Biol. Blood Marrow Transplant.. 2014 Sep;20(9):1349-55
