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. 2019 Nov;60(11):2762-2770.
doi: 10.1080/10428194.2019.1605070. Epub 2019 Apr 23.

Pre-transplant hypomethylating agents do not influence post-transplant survival in myelodysplastic syndrome

Dipenkumar Modi  1 , Seongho Kim  1 , Vijendra Singh  1 , Lois Ayash  1 , Asif Alavi  1 , Voravit Ratanatharathorn  1 , Joseph P Uberti  1 , Abhinav Deol  1
Affiliations

Pre-transplant hypomethylating agents do not influence post-transplant survival in myelodysplastic syndrome

Dipenkumar Modi et al. Leuk Lymphoma. 2019 Nov.

Abstract

Information on the use of hypomethylating agents (HMAs) as a pre-transplant cytoreductive therapy in MDS is limited. We retrospectively evaluated outcomes of 172 adult MDS patients, who underwent allogeneic hematopoietic stem cell transplantation between January 2000 and December 2016. Patients were divided into three groups: group 1 - pre-transplant blasts <5% with HMA (n = 42), group 2 - pre-transplant blasts ≥5% with HMA (n = 38), group 3 - no HMA (n = 92). With a median follow up of 4.08 years, 1-year survival and relapse rates for groups 1, 2, and 3 were 75%, 40.2%, and 60.71%, respectively; and 17.6%, 26.6%, and 9.8%, respectively. Multivariate analysis revealed adverse relapse (HR 3.54; p = .03) in group 2 compared to groups 1 and 3, while no difference in overall survival was noticed. Our study shows no survival association with pre-transplant HMA; although, higher relapse rate was observed in the non-responding patients indicating possible chemotherapy resistant disease.

Keywords: Hypomethylating agents (HMAs); azacitidine; cytoreduction in MDS; decitabine; myelodysplastic syndrome (MDS); revised international prognostic scoring system (R-IPSS).

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Conflict of interest statement

Potential conflict of interest: Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2019.1605070.

Figures

Figure 1.
Figure 1.
(a) Cumulative incidence curves for grades III and IV acute GVHD by group with disease relapse or death as competing risks. (b) Cumulative incidence curves for chronic GVHD by group with disease relapse or death as competing risks.
Figure 2.
Figure 2.
(a) Kaplan-Meier survival curves for overall survival (OS) by group. (b) Cumulative incidence curves for non-relapse mortality (NRM) by group with death with relapse as a competing risk.
Figure 3.
Figure 3.
(a) Cumulative incidence curves for relapse by group with death without relapse as a competing risk. (b) The Kaplan–Meier survival curves for relapse-free survival (RFS) by group. (c) The Kaplan–Meier survival curves for GVHD-free relapse-free survival (GRFS) by group.
See this image and copyright information in PMC

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