Outcome of therapy-related myelodysplastic syndrome and oligoblastic acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation: A propensity score matched analysis

Hidehiro Itonaga, Michiko Kida, Atsushi Hamamura, Naoyuki Uchida, Yukiyasu Ozawa, Takahiro Fukuda, Yasunori Ueda, Keisuke Kataoka, Yuta Katayama, Shuichi Ota, Ken ichi Matsuoka, Tadakazu Kondo, Tetsuya Eto, Junya Kanda, Tatsuo Ichinohe, Yoshiko Atsuta, Yasushi Miyazaki, Ken Ishiyama

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Abstract

Therapy-related myelodysplastic syndromes (t-MDS) are generally progressive and associated with poorer outcomes than de novo MDS (d-MDS). To evaluate the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for t-MDS, we conducted a propensity score matched-pair analysis of patients with t-MDS and d-MDS using a nationwide database. A total of 178 patients with t-MDS underwent allo-HSCT between 2001 and 2018, and 178 out of 3123 patients with d-MDS were selected. The probability of 3-year overall survival rate was 40.0% and 50.0% in the t-MDS and d-MDS groups, respectively (p = 0.032). The 3-year transplant-related mortality was 30.9% and 19.0% in the t-MDS and d-MDS groups, respectively (p = 0.005). The 3-year cumulative incidence of relapse was 32.8% and 33.0% in the t-MDS and d-MDS groups, respectively (p = 0.983). A multivariate analysis identified four adverse factors for overall survival in the t-MDS group: age ≥ 55 years (hazard ratio [HR], 2.09; 95% CI, 1.11–3.94; p = 0.023), the poor cytogenetic risk group (HR, 2.19; 95% CI, 1.40–4.19; p = 0.019), performance status at allo-HSCT 2–4 (HR, 2.14; 95% CI, 1.19–3.86; p = 0.011), and a shorter interval from diagnosis to transplantation (<8 months; HR, 1.61; 95% CI, 1.00–2.57; p = 0.048). The most frequent cause of transplant-related death was the infectious complications (21.6%) in t-MDS group and organ failure (12.5%) in d-MDS group. In conclusion, allo-HSCT potentially provides long-term remission in patients with t-MDS; however, further efforts to reduce transplant-related death are needed.

Original languageEnglish
JournalHematological Oncology
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • allogeneic hematopoietic stem cell transplantation
  • propensity score
  • therapy-related myelodysplastic syndrome

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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