Reduced intensity allogeneic hematopoietic stem cell transplantation for MDS using tacrolimus/sirolimus-based GVHD prophylaxis

Abstract

We report a consecutive series of 59 patients with MDS who underwent reduced-intensity hematopoietic stem cell transplantation (RI-HSCT) with fludarabine/melphalan conditioning and tacrolimus/sirolimus-based GVHD prophylaxis. Two-year OS, EFS, and relapse incidences were 75.1%, 65.2%, and 20.9%, respectively. The cumulative incidence of non-relapse mortality at 100 days, 1 year, and 2 years was 3.4%, 8.5%, and 10.5%, respectively. The incidence of grade II-IV acute GVHD was 35.4%; grade III-IV was 18.6%. Forty of 55 evaluable patients developed chronic GVHD; of these 35 were extensive grade. This RI-HSCT protocol produces encouraging outcomes in MDS patients, and tacrolimus/sirolimus-based GVHD prophylaxis may contribute to that promising result.

Figure 1. Outcomes

Panel A shows the probability of overall survival, from date of transplant to death from any cause and Panel B shows event-free survival from date of transplant to death, relapse, progression, second transplant or engraftment failure., Panel C depicts the cumulative incidence of relapse/progression (RI), and Panel D, the cumulative incidence of non-relapse mortality (NRM), RI and NRM were calculated as competing risks. Non-engraftment was also treated as a competing risk for both RI and NRM.