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. 2013 Sep 12;122(11):1974-82.
doi: 10.1182/blood-2013-04-496778. Epub 2013 Jul 11.

Impact of donor source on hematopoietic cell transplantation outcomes for patients with myelodysplastic syndromes (MDS)

Wael Saber  1 , Corey S Cutler, Ryotaro Nakamura, Mei-Jie Zhang, Ehab Atallah, J Douglas Rizzo, Richard T Maziarz, Jorge Cortes, Matt E Kalaycio, Mary M Horowitz
Affiliations

Impact of donor source on hematopoietic cell transplantation outcomes for patients with myelodysplastic syndromes (MDS)

Wael Saber et al. Blood. .

Abstract

Allogeneic hematopoietic cell transplantation (HCT) from human leukocyte antigen (HLA) matched related donor (MRD) and matched unrelated donors (MUD) produces similar survival for patients with acute myelogenous leukemia. Whether these results can be extended to patients with myelodysplastic syndromes (MDS) is unknown. Therefore, analysis of post-HCT outcomes for MDS was performed. Outcomes of 701 adult MDS patients who underwent HCT between 2002 and 2006 were analyzed (MRD [n = 176], 8 of 8 HLA-A, -B, -C, -DRB1 allele matched MUD [n = 413], 7 of 8 MUD [ n = 112]). Median age was 53 years (range, 22-78 years). In multivariate analyses, MRD HCT recipients had similar disease free survival (DFS) and survival rates compared with 8 of 8 MUD HCT recipients (relative risk [RR] 1.13 [95% confidence interval (CI) 0.91-1.42] and 1.24 [95% CI 0.98-1.56], respectively), and both MRD and 8 of 8 MUD had superior DFS (RR 1.47 [95% CI 1.10-1.96] and 1.29 [95% CI 1.00-1.66], respectively) and survival (RR 1.62 [95% CI 1.21-2.17] and 1.30 [95% CI 1.01-1.68], respectively) compared with 7 of 8 MUD HCT recipients. In patients with MDS, MRD remains the best stem cell source followed by 8 of 8 MUD. Transplantation from 7 of 8 MUD is associated with significantly poorer outcomes.

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Figures

Figure 1
Figure 1
Adjusted probability of transplant-related mortality in adult MDS patients by donor source. In multivariate analysis, the risk of transplant-related mortality was lower in MRD HCT recipients compared with both MUD groups (RR 1.44 (95% CI 1.06-1.95) and 1.80 (95% CI 1.23-2.63) for 8/8 MUD and 7/8 MUD HCT recipients, respectively).
Figure 2
Figure 2
Adjusted probability of relapse in adult MDS patients by donor source. In multivariate analysis there was no difference in the risk of relapse among the three groups.
Figure 3
Figure 3
Adjusted probability of DFS in 694 adult MDS patients by donor source. In multivariate analysis, the risk of treatment failure (death or relapse) was significantly higher with 7 of 8 MUD HCT recipients compared with MRD and 8 of 8 MUD HCT recipients (RR 1.47 [95% CI 1.10-1.96] and 1.29 [95% CI 1.00-1.66], respectively). The risk was not different between 8 of 8 MUD and MRD HCT recipients (RR 1.13, 95% CI 0.91-1.42).
Figure 4
Figure 4
Adjusted probability of overall survival in 701 adult MDS patients by donor source. In multivariate analysis, the risk of all-cause mortality was significantly higher with 7 of 8 MUD HCT recipients compared with MRD and 8 of 8 MUD HCT recipients (RR 1.62 [95% CI 1.21-2.17] and 1.30 [95% CI 1.01-1.68], respectively). The risk was not different between 8 of 8 MUD and MRD HCT recipients (RR 1.24, 95% CI 0.98-1.56).
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References

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