HLA-matched allogeneic stem cell transplantation improves outcome of higher risk myelodysplastic syndrome A prospective study on behalf of SFGM-TC and GFM
M Robin
(1, 2)
,
R. Porcher
(3, 4)
,
L. Ades
(1)
,
E. Raffoux
(1)
,
M. Michallet
(5)
,
S François
(6)
,
J-y Cahn
(7)
,
A. Delmer
(8)
,
E. Wattel
(5)
,
S Vigouroux
(9)
,
J-O Bay
(10)
,
J. Cornillon
(11)
,
A. Huynh
(12)
,
Son Nguyen
(13)
,
M.T. Rubio
(14)
,
L. Vincent
(15, 16)
,
N. Maillard
(17)
,
A. Charbonnier
(18)
,
R.P. de Latour
(1, 2)
,
O. Reman
(19)
,
H. Dombret
(20, 21)
,
P. Fenaux
(20, 21)
,
G. Socie
(1, 2)
1
Hôpital Saint-Louis
2 A2T - Alloimmunité-Autoimmunité-Transplantation
3 CRESS - U1153 - Equipe 5 : METHODS - Méthodes de l’évaluation thérapeutique des maladies chroniques
4 Centre d'épidémiologie Clinique [Hôtel-Dieu]
5 HCL - Hospices Civils de Lyon
6 CHU Angers - Centre Hospitalier Universitaire d'Angers
7 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
8 Service d'hématologie [Reims]
9 Service d'Hématologie [Bordeaux]
10 CHU Clermont-Ferrand
11 Institut de Cancérologie de la Loire Lucien Neuwirth
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 CHU Pitié-Salpêtrière [AP-HP]
14 CHU Saint-Antoine [AP-HP]
15 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
16 IBMM - Institut des Biomolécules Max Mousseron [Pôle Chimie Balard]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 CHU Amiens-Picardie
19 Laboratoire d'Hématologie Biologique [CHU Caen]
20 AP-HP - Hopital Saint-Louis [AP-HP]
21 Hôpital Avicenne [AP-HP]
2 A2T - Alloimmunité-Autoimmunité-Transplantation
3 CRESS - U1153 - Equipe 5 : METHODS - Méthodes de l’évaluation thérapeutique des maladies chroniques
4 Centre d'épidémiologie Clinique [Hôtel-Dieu]
5 HCL - Hospices Civils de Lyon
6 CHU Angers - Centre Hospitalier Universitaire d'Angers
7 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
8 Service d'hématologie [Reims]
9 Service d'Hématologie [Bordeaux]
10 CHU Clermont-Ferrand
11 Institut de Cancérologie de la Loire Lucien Neuwirth
12 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
13 CHU Pitié-Salpêtrière [AP-HP]
14 CHU Saint-Antoine [AP-HP]
15 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
16 IBMM - Institut des Biomolécules Max Mousseron [Pôle Chimie Balard]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 CHU Amiens-Picardie
19 Laboratoire d'Hématologie Biologique [CHU Caen]
20 AP-HP - Hopital Saint-Louis [AP-HP]
21 Hôpital Avicenne [AP-HP]
L. Ades
- Fonction : Auteur
- PersonId : 762488
- ORCID : 0000-0002-9020-8766
- IdRef : 060593512
N. Maillard
- Fonction : Auteur
- PersonId : 755878
- ORCID : 0000-0002-3073-7252
- IdRef : 167908944
Résumé
Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the only a curative treatment in patients with higher risk myelodysplastic syndrome (MDS), although demethylating agents (DMA) have been reported to improve survival. The advantage of HSCT over other treatment comes from retrospective studies and the aim of the current study was to prospectively test this hypothesis, analyzing in particular patients from the pre-transplant period to avoid the selection bias of performing transplantation. This study was conducted to compare overall survival in MDS patients candidates to transplantation according to donor availability. The majority of patients (76%) received a treatment with DMA after registration, 69% had a human leukocyte antigen (HLA)-identical donor, 70% of whom were transplanted. Baseline patient and disease characteristics were similar according to donor availability. Four-year overall survival was significantly better in patients with an HLA matched donor (37%) compared to patients without donor (15%). There was also evidence that this overall survival advantage was because of transplantation. Mortality risk was decreased after transplantation but it became significant only after the second year post transplant, because of early transplant-related mortality. Our results appear to justify, in higher risk MDS, a transplantation approach in all potential candidates who have an HLA identical donor.