Allogeneic Stem Cell Transplantation in Therapy-Related Myelodysplasia after Autologous Transplantation for Lymphoma: A Retrospective Study of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy

Jaimes-Albornoz, Daniel;Mannone, Lionel;Nguyen-Quoc, Stéphanie;Chalandon, Yves;Gyan, Emmanuel;et.al.
(2019) Biology of Blood and Marrow Transplantation — Vol. 25, n° 12, p. 2366-2374 (2019)

Files

2019-PX.pdf
  • Open Access
  • Adobe PDF
  • 716.85 KB
Download

Details

Authors
  • Jaimes-Albornoz, Daniel
    Author
  • Mannone, Lionel
    Author
  • Nguyen-Quoc, Stéphanie
    Author
  • Chalandon, Yves
    Author
  • Poire, XavierUCLouvain
    Author
  • Gyan, Emmanuel
    Author
Show more
Abstract
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 to 71 years) at transplantation and a median follow-up of 22 months (range, 0.7 to 107). The median overall survival (OS) was 6.9 months (95% confidence interval [CI], 0 to 19 months). OS rates were 45% (29% to 60%) and 30% (15% to 45%) at 1 and 3 years after transplantation, respectively. On univariate analysis, prior therapy for t-MDS before allo-HSCT (P = .02) and mismatched donors (P = .004) were associated with poor OS. Three-year nonrelapse mortality (NRM) and relapse rates were 44% (25% to 63%) and 41% (22% to 61%), respectively. Mismatched donors (P < .001) were associated with higher NRM and a high-risk MDS (P = .008) with a higher relapse risk. On multivariate analysis, HLA mismatch was associated with higher NRM (hazard ratio, 6.21; 95% CI, 1.63 to 23.62; P = .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 graft-versus-host disease prophylaxis should be avoided in such an indication for allo-HSCT. It will be worthwhile to see if the implementation of cyclophosphamide post-transplantation will improve the outcome with mismatched donors.
Affiliations

Citations

  • APA
  • Chicago
  • FWB

Jaimes-Albornoz, D., Mannone, L., Nguyen-Quoc, S., Chalandon, Y., Chevallier, P., Mohty, M., Meunier, M., Robin, M., Ledoux, M.-P., Guillerm, G., Bay, J.-O., Poire, X., Maillard, N., Leclerc, M., Daguindau, E., Beguin, Y., Rubio, M. T., & Gyan, E. (2019). Allogeneic Stem Cell Transplantation in Therapy-Related Myelodysplasia after Autologous Transplantation for Lymphoma: A Retrospective Study of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy. Biology of Blood and Marrow Transplantation, 25(12), 2366-2374. https://doi.org/10.1016/j.bbmt.2019.07.013 (Original work published 2019)