Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 29.
doi: 10.1038/s41409-025-02682-3. Online ahead of print.

Conditioning intensity in myelodysplastic patients aged ≥ 50 years undergoing allogeneic hematopoietic cell transplantation (allo-HCT): a study on behalf of the chronic malignancies working party of the EBMT

Noureddine Henoun Loukili  1 , Luuk Gras  2 , Linda Koster  2 , Didier Blaise  3 , Tobias Gedde-Dahl  4 , Johan Maertens  5 , Lone Smidstrup Friis  5   6 , Stephan Mielke  6 , Patrice Chevallier  7 , Jakob R Passweg  8   9   10 , Jennifer Louise Byrne  11 , Urpu Salmenniemi  10 , Patrice Ceballos  12 , Jérôme Cornillon  13 , Simona Sica  14 , Francesco Onida  15   16 , Christof Scheid  17 , Carmelo Gurnari  18 , Joanna Drozd-Sokolowska  19 , Kavita Raj  20 , Marie Robin  21 , Donal P McLornan  22 , Ibrahim Yakoub-Agha  23
Affiliations

Conditioning intensity in myelodysplastic patients aged ≥ 50 years undergoing allogeneic hematopoietic cell transplantation (allo-HCT): a study on behalf of the chronic malignancies working party of the EBMT

Noureddine Henoun Loukili et al. Bone Marrow Transplant. .

Abstract

Reduced intensity conditioning (RIC) is usually used for patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (allo-HCT), particularly in the elderly or those with comorbidities. The impact of conditioning intensity on patients' outcome remains controversial with clinicians' subjective opinion/ experience remaining a major guide in choosing the intensity. Here, we compare RIC versus MAC in a large EBMT retrospective study in MDS patients aged ≥50 years undergoing allo-HCT between 2014 and 2018. Among the 1393 included patients, 922 (66%) were males, and the median age at transplant was 62.8 (50.0-77.9) years. The majority of patients (n = 884; 64.3%) had MDS with excess blasts. IPSS-R recorded was very low/low (n = 598, 43%), intermediate (n = 352, 25%), and high/very high (n = 443, 32%). Karnofsky index was ≥90 in 916 (69.3%) patients, and HCT-CI ≥ 3 in 292(27.3%) patients. A RIC regimen was used in 1053 (75.5%) patients. Median follow-up was 27.9 months (IQR: 26.4-30.6). Both uni- and multi-variable analyses did not show any significant association between conditioning intensity and outcomes. This study highlights a lack of association between RIC/MAC regimens and outcomes in allo-HCT MDS patients. Our results support the recently published systematic review and meta-analysis, where evidence for using one conditioning regimen over another remains weak.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The scientific boards of the Chronic Malignancies Working Party of the EBMT approved this study. The study was performed in accordance with the Declaration of Helsinki and approved by the Sheba Medical Center Helsinki Committee (SMC-770920). Informed consent was obtained from all subjects.

References

    1. Fenaux P, Platzbecker U, Mufti GJ, Garcia-Manero G, Buckstein R, Santini V, et al. Luspatercept in Patients with Lower-Risk Myelodysplastic Syndromes. N. Engl J Med. 2020;382:140–51. - PubMed
    1. Sekeres MA, Taylor J. Diagnosis and Treatment of Myelodysplastic Syndromes: A Review. JAMA. 2022;328:872–80. - PubMed
    1. Robin M, de Witte T. Myelodysplastic Syndromes. In: Carreras E, Dufour C, Mohty M, Kroger N, editors. The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies. 7th ed. Cham (CH) 2019. p. 547-56.
    1. Shimoni A, Robin M, Iacobelli S, Beelen D, Mufti GJ, Ciceri F, et al. Allogeneic hematopoietic cell transplantation in patients with myelodysplastic syndrome using treosulfan based compared to other reduced-intensity or myeloablative conditioning regimens. A report of the chronic malignancies working party of the EBMT. Br J Haematol. 2021;195:417–28. - PubMed
    1. Martino R, Henseler A, van Lint M, Schaap N, Finke J, Beelen D, et al. Long-term follow-up of a retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic transplantation from matched related donors in myelodysplastic syndromes. Bone Marrow Transpl. 2017;52:1107–12.

LinkOut - more resources