1. 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.
- Author
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Jaimes-Albornoz, Daniel, Mannone, Lionel, Nguyen-Quoc, Stéphanie, Chalandon, Yves, Chevallier, Patrice, Mohty, Mohamad, Meunier, Mathieu, Robin, Marie, Ledoux, Marie-Pierre, Guillerm, Gaëlle, Bay, Jacques-Olivier, Poiré, Xavier, Maillard, Natacha, Leclerc, Mathieu, Daguindau, Etienne, Beguin, Yves, Rubio, Marie Thérèse, and Gyan, Emmanuel
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BONE marrow transplantation , *STEM cell transplantation , *CELL transplantation , *AUTOTRANSPLANTATION , *CELLULAR therapy , *ALEMTUZUMAB , *LYMPHOPROLIFERATIVE disorders - Abstract
• Patients who undergo autologous stem cell transplantation (ASCT) for lymphoma and develop therapy-related myelodysplastic syndrome (t-MDS) have a short overall survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT). • The use of donors with mismatched HLA is associated with a higher nonrelapse mortality. • Despite advances in allo-HSCT, patients with t-MDS remain a critical population with few therapeutic alternatives. 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. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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