Induction chemotherapy followed by allogeneic HCT versus upfront allogeneic HCT for advanced myelodysplastic syndrome

A propensity score matched analysis

Adult Myelodysplastic Syndrome Working Group of the Japan Society for Hematopoietic Cell Transplantation

Research output: Contribution to journalArticle

Abstract

To reduce post-transplant relapse, acute myeloid leukemia (AML) type remission induction chemotherapy has been attempted to reduce disease burden before allogeneic hematopoietic cell transplantation (HCT) in patients with advanced myelodysplastic syndrome (MDS). However, the efficacy of induction chemotherapy before HCT is unclear. We retrospectively analyzed the Japanese registration data of 605 adult patients, who had received allogeneic HCT for advanced MDS between 2001 and 2016, to compare the post-transplant relapse between patients who received induction chemotherapy followed by allogeneic HCT and those who received upfront HCT. Propensity score matching identified 230 patients from each cohort. There were no significant differences in overall survival and non-relapse mortality between the two groups. The cumulative incidence of relapse was significantly higher in patients who received induction chemotherapy than those who received upfront HCT. In the subgroup analyses, upfront HCT had a significantly reduced relapse incidence among patients with poor cytogenetics, those with higher international prognostic scoring system at diagnosis, and those who received reduced-intensity conditioning. Our results suggested that AML type remission induction chemotherapy before HCT did not improve post-transplant relapse and survival for adult patients with advanced MDS. Upfront HCT is preferable for patients with a poor karyotype.

Original languageEnglish
JournalHematological Oncology
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Propensity Score
Induction Chemotherapy
Myelodysplastic Syndromes
Cell Transplantation
Recurrence
Remission Induction
Transplants
Acute Myeloid Leukemia
Survival
Incidence
Karyotype
Cytogenetics
Mortality

Keywords

  • allogeneic hematopoietic cell transplantation
  • cytoreductive treatment
  • induction chemotherapy
  • myelodysplastic syndrome
  • propensity score matched analysis
  • relapse

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Induction chemotherapy followed by allogeneic HCT versus upfront allogeneic HCT for advanced myelodysplastic syndrome : A propensity score matched analysis. / Adult Myelodysplastic Syndrome Working Group of the Japan Society for Hematopoietic Cell Transplantation.

In: Hematological Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Adult Myelodysplastic Syndrome Working Group of the Japan Society for Hematopoietic Cell Transplantation. / Induction chemotherapy followed by allogeneic HCT versus upfront allogeneic HCT for advanced myelodysplastic syndrome : A propensity score matched analysis. In: Hematological Oncology. 2018.
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abstract = "To reduce post-transplant relapse, acute myeloid leukemia (AML) type remission induction chemotherapy has been attempted to reduce disease burden before allogeneic hematopoietic cell transplantation (HCT) in patients with advanced myelodysplastic syndrome (MDS). However, the efficacy of induction chemotherapy before HCT is unclear. We retrospectively analyzed the Japanese registration data of 605 adult patients, who had received allogeneic HCT for advanced MDS between 2001 and 2016, to compare the post-transplant relapse between patients who received induction chemotherapy followed by allogeneic HCT and those who received upfront HCT. Propensity score matching identified 230 patients from each cohort. There were no significant differences in overall survival and non-relapse mortality between the two groups. The cumulative incidence of relapse was significantly higher in patients who received induction chemotherapy than those who received upfront HCT. In the subgroup analyses, upfront HCT had a significantly reduced relapse incidence among patients with poor cytogenetics, those with higher international prognostic scoring system at diagnosis, and those who received reduced-intensity conditioning. Our results suggested that AML type remission induction chemotherapy before HCT did not improve post-transplant relapse and survival for adult patients with advanced MDS. Upfront HCT is preferable for patients with a poor karyotype.",
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AU - Konuma, Takaaki

AU - Shimomura, Yoshimitsu

AU - Ozawa, Yukiyasu

AU - Ueda, Yasunori

AU - Uchida, Naoyuki

AU - Onizuka, Makoto

AU - Akiyama, Megumi

AU - Mori, Takehiko

AU - Nakamae, Hirohisa

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AU - Shiratori, Souichi

AU - Onishi, Yasushi

AU - Kanda, Yoshinobu

AU - Fukuda, Takahiro

AU - Atsuta, Yoshiko

AU - Ishiyama, Ken

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