Comparison of Upfront Transplantation and Pretransplant Cytoreductive Therapy for Advanced Myelodysplastic Syndrome.
Comparison of Upfront Transplantation and Pretransplant Cytoreductive Therapy for Advanced Myelodysplastic Syndrome.
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DOI：
10.1016/j.clml.2021.04.015
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
Hong Wang;Yan Li;Qingyu Xu;Wei Zhou;Chengliang Yin;Ruiqi Wang;Mengzhen Wang;Yuan-yuan Xu;Yonghui Li;Li Yu
中科院分区：
文献类型：
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作者：
Hong Wang;Yan Li;Qingyu Xu;Wei Zhou;Chengliang Yin;Ruiqi Wang;Mengzhen Wang;Yuan-yuan Xu;Yonghui Li;Li Yu
背景：同种异体造血干细胞移植（alloo - hsct）是晚期骨髓增生异常综合征（MDS）唯一的治疗方法。然而，移植前细胞减少的价值仍有争议。患者和方法我们回顾性比较了前期移植和移植前细胞减少的结果。69例患者中，39例接受了前期同种异体造血干细胞移植，30例接受了移植前细胞减少，包括化疗（n= 16）、低甲基化药物（HMAs,n= 6）和HMAs联合化疗（n= 8）。结果与细胞减少组相比，前期组获得了相似的总生存期（OS），并有更好的无进展生存期（PFS）趋势（3年PFS， 64.0%vs.44.4%，P= 0.076）。两组移植后的预后在OS、无复发生存（RFS）、累积复发发生率（CIR）和非复发死亡率（NRM）方面具有可比性。在≥2个突变的患者中，前期组的OS和PFS（3年OS: 100.0%vs.68.6%，P= 0.044； 3年PFS: 92.3%vs.43.9%，P= 0.016）均优于细胞减少组。在细胞减少组中获得缓解的患者的结果与前期组相似，但移植前无缓解的患者移植后OS明显更差（3年OS， 46.7%vs.75.7%，P= 0.038）。移植前HMAs患者的PFS优于化疗组或HMAs +化疗组（P< 0.05）。结论与移植前细胞减少相比，在有合适供体的情况下，前期移植对部分晚期MDS患者有更大的益处。在寻找捐赠者的过程中，hma将是一个很好的选择。
BackgroundAllogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative therapy for advanced myelodysplastic syndrome (MDS). However, the value of pretransplant cytoreduction remains debatable.Patients and MethodsWe retrospectively compared the outcomes of upfront transplantation and pretransplant cytoreduction. Of 69 patients, 39 received upfront allo-HSCT and 30 received pretransplant cytoreduction, including chemotherapy (n= 16), hypomethylating agents (HMAs,n= 6), and HMAs with chemotherapy (n= 8).ResultsThe upfront group achieved similar overall survival (OS) and a trend of better progression-free survival (PFS) from diagnosis compared with the cytoreduction group (3-year PFS, 64.0%vs.44.4%,P= .076). Posttransplant outcomes were comparable between the two groups in terms of OS, relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM). In patients with ≥2 mutations, the upfront group achieved better OS and PFS (3-year OS, 100.0%vs.68.6%,P= .044; 3-year PFS: 92.3%vs.43.9%,P= .016) than the cytoreduction group. Patients achieving remission in the cytoreduction group had outcomes similar to the upfront group, but those without remission before transplantation had a significantly worse posttransplant OS (3-year OS, 46.7%vs.75.7%,P= .038). Patients with pretransplant HMAs had better PFS than those with chemotherapy or HMAs plus chemotherapy (P< 0.05).ConclusionCompared with pretransplant cytoreduction, upfront allo-HSCT might provide more benefit to some patients with advanced MDS if there are suitable donors. HMAs would be a good alternative during the donor search.