Allogeneic hemаtоpoietic stem cell transplantation with reduced-intensity conditioning in patients with myelodysplastic syndrome

Cellular Therapy and Transplantation

Boris V. Afanasyev¹  Yulia V. Rudnitskaya¹  Ludmila S. Zubarovskaya¹  Elena V. Morozova¹  Yuriy R. Zalyalov¹  Vladimir A. Kostorov¹ 

关键词: myelodysplastic syndrome;    allogeneic HSCT;    reduced-intensity conditioning regimens;   

DOI  :  10.3205/ctt-2010-No9-abstract09

学科分类：肿瘤学

来源: Universitaetsklinikum Hamburg - Eppendorf / University Medical Center Hamburg - Eppendorf

【 摘 要 】

Allogeneichematopoieticstemcelltransplantation(alloHSCT)istheonlycurativetreatmentforpatientswithmyelodysplasticsyndrome(MDS).Nevertheless,alloHSCTinMDSpatientsisassociatedwithahighmortalityratearoundthetransplantprocedure(graftrejectionorfailure,graft-versus-hostdisease(GVHD),infectiouscomplications).MDSismorecommoninpersonsover40yearswithanumberofassociateddiseases.Thereforelong-termsurvivalafteralloHSCTinMDSmayalsodependonthetoxicityoftheconditioningregimens.Myeloablativeconditioningregimens(MCR)andthereducedintensityconditioning(RIC)areusedforalloHSCTinMDSpatients.MCRisfrequentlyassociatedwiththedevelopmentoforganfailure,severemucositis,venoocclusivedisease,andinfertility.TheRICregimenislesstoxic,buttheuseofRICmayincreasethefrequencyofrelapseafterHSCT.Objective:ToevaluatetheeffectivenessofRICalloHSCTfrombothrelatedandunrelateddonorsinpatientswithhighriskMDSindifferentagegroups.nbsp;Materialsandmethods:AlloHSCTwasperformedin12patients(5weretransplantedfrommatchedrelateddonors,and7frommatchedunrelateddonors).Fourpatientsunderwentasecondallo-HSCTfromthesamedonorafterrelapseorengraftmentfailure.Themedianpatientagewas24(7–53)years.AccordingtotheIPSSscoringsystem,4patientsbelongedtothehigh-riskgroup,4totheintermediate-1group,and4totheintermediate-2group.Allpatientsreceivedfludarabine-basedRICregimens.PreventionofacuteGVHDwasperformedwithtacrolimusorcyclosporineAandwithmethotrexate(shortcourse).InthecaseofunrelatedalloHSCT,horseantithymocyteglobulinatadoseof60–80mg/kgwasalsousedforGVHDprophylaxis.nbsp;Results:Four-yearoverallsurvival(OS)was63%,and4-yearevent-freesurvival(EFS)was40%.Four-yeartransplantrelatedmortality(TRM)afterunrelatedalloHSCTdidnotexceed20%andwascomparablewithTRMafteralloHSCTfromrelateddonors(25%).In12%ofpatients,thedevelopmentofsevereacuteGVHD(III–IVdegree)wasnoted.Causesofdeathwerethefollowing:acuteGVHD(25%),primarygraftfailure(25%),progressionofdisease(25%),andinfectiouscomplications(25%).Conclusions:PreliminaryresultsshowedtheeffectivenessofregimeswithreducedintensityinpatientswithMDSathighriskindifferentagegroups.Four-yearTRMinalloHSCTfromanunrelateddonorwascomparablewiththeTRMrateinalloHSCTfromarelateddonor.Preventionandwell-timedtreatmentofposttransplantcomplicationsmayincreaseoverallsurvivalandimprovequalityoflife.

【 授权许可】

Unknown