HLA-matched allogeneic stem cell transplantation improves outcome of higher risk myelodysplastic syndrome A prospective study on behalf of SFGM-TC and GFM.

Fiche publication


Date publication

juillet 2015

Journal

Leukemia

Auteurs

Membres identifiés du Cancéropôle Est :
Pr RUBIO Marie Thérèse , Pr DELMER Alain


Tous les auteurs :
Robin M, Porcher R, Adès L, Raffoux E, Michallet M, François S, Cahn JY, Delmer A, Wattel E, Vigouroux S, Bay JO, Cornillon J, Huynh A, Nguyen S, Rubio MT, Vincent L, Maillard N, Charbonnier A, de Latour RP, Reman O, Dombret H, Fenaux P, Socié G

Résumé

Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only a curative treatment in patients with higher risk myelodysplastic syndrome (MDS), although demethylating agents (DMA) have been reported to improve survival. The advantage of HSCT over other treatment comes from retrospective studies and the aim of the current study was to prospectively test this hypothesis, analyzing in particular patients from the pre-transplant period to avoid the selection bias of performing transplantation. This study was conducted to compare overall survival in MDS patients candidates to transplantation according to donor availability. The majority of patients (76%) received a treatment with DMA after registration, 69% had a human leukocyte antigen (HLA)-identical donor, 70% of whom were transplanted. Baseline patient and disease characteristics were similar according to donor availability. Four-year overall survival was significantly better in patients with an HLA matched donor (37%) compared to patients without donor (15%). There was also evidence that this overall survival advantage was because of transplantation. Mortality risk was decreased after transplantation but it became significant only after the second year post transplant, because of early transplant-related mortality. Our results appear to justify, in higher risk MDS, a transplantation approach in all potential candidates who have an HLA identical donor.

Mots clés

Aged, Antineoplastic Combined Chemotherapy Protocols, therapeutic use, Combined Modality Therapy, Female, Follow-Up Studies, HLA Antigens, immunology, Histocompatibility Testing, Humans, Male, Middle Aged, Myelodysplastic Syndromes, immunology, Neoplasm Staging, Prognosis, Prospective Studies, Retrospective Studies, Risk Factors, Stem Cell Transplantation, Survival Rate, Transplantation Conditioning, Transplantation, Homologous

Référence

Leukemia. 2015 Jul;29(7):1496-501