Allogeneic stem cell transplantation in therapy-related myelodysplasia after autologous transplantation for lymphoma: a retrospective study of the SFGM-TC.

Fiche publication

Date publication

juillet 2019

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 , Dr DAGUINDAU Etienne

Tous les auteurs :
Jaimes-Albornoz D, Mannone L, Nguyen-Quoc S, Chalandon Y, Chevallier P, Mohty M, Meunier M, Robin M, Ledoux MP, Guillerm G, Bay JO, Poiré X, Maillard N, Leclerc M, Daguindau E, Beguin Y, Rubio MT, Gyan E

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/31326611

Résumé

Therapy-related myelodysplastic syndrome (t-MDS) after autologous stem-cell transplantation (ASCT) is a rare complication with no curative option. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be considered for eligible patients and has been understudied in t-MDS. We report 47 consecutive patients with t-MDS after an ASCT who underwent allo-HSCT with a median age of 58 years (range: 30-71) at transplantation and a median follow-up of 22 months (range: 0.7-107). The median overall survival (OS) was 6.9 months (95% confidence interval, 0-19). OS rates were 45% (29-60%) and 30% (15-45%) at 1 and 3 years after transplantation, respectively. On univariate analysis prior therapy for t-MDS before allo-HSCT (p=0.02) and mismatched donors (p=0.004) were associated with poor OS. Three-year non-relapse mortality (NRM) and relapse rates were 44% (25-63%) and 41% (22-61%), respectively. Mismatched donors (p<0.001) were associated with higher NRM and a high-risk MDS (p=0.008) with a higher relapse risk. On multivariate analysis HLA mismatch was associated with higher NRM (HR 6.21; 95% CI 1.63-23.62; p=0.007). In conclusion, our results suggest that one third of the patients who develop t-MDS after an ASCT for lymphoma are cured after an allo-HSCT. The use of mismatched donors with standard GVHD prophylaxis should be avoided in such indication for allo-HSCT. It will be worth to see if the implementation of CY post-transplantation will improve the outcome with mismatched donors.