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Myelodysplastic syndromes (MDS) are a heterogeneous group of hematologic diseases, characterized by a clonal abnormality of hematopoietic stem cells. The incidence of MDS is age-dependent. The treatment approach is to categorize patients into lower or higher risk MDS and to select a suitable treatment accordingly. HCT offers potentially curative therapy for patients with MDS. A reduced intensity conditioning (RIC) regimen was used to reduce the toxicities associated with transplant procedure. The main concept of RIC relay upon adoptive immunotherapy especially in the low risk patients allowing the graft versus leukemia to occur.

This study aimed to investigate the outcome of allogeneic peripheral blood stem cell transplantation after reduced intensity conditioning regimen for adult patients with MDS, the effect of different prognostic factors on outcome and the effect of chronic GVHD according to IPSS risk.

A retrospectively study analyzed the fifty-one patients with MDS who underwent transplantation at the BMT unit at Nasser Institute during a period of 10 years, by the RIC regimen from HLA identical donor using peripheral blood stem cell. Outcomes analyzed the incidence of acute and chronic GVHD, disease free survival (DFS) & overall survival (OS).

They were 31 males (60.8%) and 20 females (39.2%). Their ages ranged from 17 to 60 years, with mean age ± SD of 34.5 ± 10.1 years, including refractory cytopenia with multiple dysplasia (RCMD) in 14 patients (27.5%), MDS –U in 13 patients (25.5%), refractory anemia (RA) in 12 patients (23.5%), refractory anemia with excess blasts II (RAEB II) in 6 patients (11.8%) and MDS with hypocellular bone marrow in 4 patients (7.8%) and refractory anemia ring sideroblasts (RARS) in 2 patients (2%). According to IPSS classification, 11 patients (21.6%) were low risk, 28 patients (54.9%) were intermediate-I risk group, and 9 patients (17.5%) were intermediate-II & 3 patients (5%) were high risk group. The incidence of acute and chronic GVHD were 51.1% and 28.6% respectively. The 5- year estimate for overall survival of the whole group was 21.8%. In univariate analysis, covariates associated with a better OS were recipient age < 40 years (p=0.02) and the presence of cGVHD (p=.002). On multivariate analysis the presence of cGVHD is significant predictor of survival (p=0.04). Also cGVHD significantly improve the OS for low and high risk MDS group (p= 0.02 and 0.03 respectively). While presence of acute GVHD, IPSS & interval between diagnosis and transplant weren’t significantly affect OS (p> 0.05). The 5- year estimate for DFS of the whole group was 28.6%. On multivariate analysis the presence of cGVHD significantly reduce relapse (p = 0.029).

The presence of cGVHD significantly improved OS and reduced the risk of relapse in patients with MDS. We also found that the presence of cGVHD significantly improved OS especially in high-risk patients group, which suggests that the GVL effect may be beneficial in high-risk patients who do not receive intensive preparative regimens.