Contributions
Abstract: PB1629
Type: Publication Only
Session title: Myelodysplastic syndromes - Clinical
Background
Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders of pluripotent stem cells, characterized by ineffective hematopoiesis, richmarrow dysplasia resulting in cytopenias. In addition, MDS frequently progresses to acute myeloid leukemia and is the most common preleukemic state in adults. Allogeneic hematopoietic stem cell transplantation (HSCT) currently is the only potentially curative therapy for MDS. It can be performed in patients (pts) aged less than 60 years from an HLA compatible or haplo-identical donor.
Aims
Long term series study
Methods
Between May 2001 to March 2019 (18 years period), thirty four pts with MDS underwent allogeneic HSCT (geno-identical: 31 pts, haplo-identical: 3 pts). The median age of the pts is 36 years (4 - 58), the Sex ratio is 1,42 (20M/14F). Median time from diagnosis to allogeneic HSCT was 11 months (2-81). The pre-transplant status of pts according to the WHO 2016 classification is (MDS with unilineage dysplasia: 4 including 2 with ring sideroblasts and 1 with isolated del 5q, MDS with multilineage dysplasia: 30 including 07 with excess blasts-1 and 09 with excess blasts -2). The treatments received before the transplant are: Ciclosporin: 07 pts, EPO: 07 pts, Danazol: 03 pts, Revlimid: 02 pts, Azacytidine: 01 pt, Aracytine: 01 pt, Rituximab: 01 pt and 33 pts were transfusion-dependent before the graft with an average of 32 RBC unit/ pt (3 - 135). All the patients received myeloablative conditioning [classic MAC: 13 pts (Santos, TUTSHKA, Haplo); Flu-Bu4: 21 pts]. GVHD prophylaxis consisted on association of Cyclosporin and Methotrexate according to the Seattle protocol in 31 pts of which 10 pts received anti thymocyte globulin; Post-transplant Endoxan and Mycophenolate mofetil without Methotrexate for 3 pts. All pts received G-CSF alone mobilised peripheral blood stem cells, with a median CD34+ cell count: 7,62.106 / kg (3.18-19.9). In addition to the CSP graft, one patient received a bone marrow graft.
Results
Neutropenia occured in all pts and the median duration of aplasia was14 (7-31) days. Median time to achieve neutrophils count > 0,5.109/l: 14 days (11-25) and platelets > 20.109/l: 13 days (9-35). Thirty pts (88%) required red blood cells transfusion (8.7 unit/pt) and 31 pts (91%) needed platelet transfusions (6.6 units/pt). Three pts (8.8%) presented VOD, one of which was severe. Grade II-IV acute GVHD was observed in 08/26 pts (30.7%) and chronic GVHD in 11/20 pts (55%) of whom 5 with an extensive form. Relapse was observed in 2/26 pts (7.6%) within 4 and 20 months post transplant. At July 31, 2020, the median follow-up is 94.5 months (16-202), 16 pts (47%) are still alive (15 pts in complete remission and 1 pts in relapse on Azacytidine), 18 pts (53%) are died including 17 pts (50%) of TRM (early infection: 06, VOD: 01, thrombotic microangiopathy: 1, acute GVHD: 04, pneumopathy: 02, fulminant hepatitis: 01, metabolic disorders: 02) and 1 pt of relapse . The overall survival (OS) is 47%, relapse-free survival (EFS) 44%, and GVHD-free and relapse-free survival (GRFS) 32%.
Conclusion
Allogeneic HSCT, in our study, was a curative option in 44% of patients with MDS with 16 years of follow-up. Thirty-two% are alive with a good quality of life.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Long-term follow-up, Myelodysplasia
Abstract: PB1629
Type: Publication Only
Session title: Myelodysplastic syndromes - Clinical
Background
Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders of pluripotent stem cells, characterized by ineffective hematopoiesis, richmarrow dysplasia resulting in cytopenias. In addition, MDS frequently progresses to acute myeloid leukemia and is the most common preleukemic state in adults. Allogeneic hematopoietic stem cell transplantation (HSCT) currently is the only potentially curative therapy for MDS. It can be performed in patients (pts) aged less than 60 years from an HLA compatible or haplo-identical donor.
Aims
Long term series study
Methods
Between May 2001 to March 2019 (18 years period), thirty four pts with MDS underwent allogeneic HSCT (geno-identical: 31 pts, haplo-identical: 3 pts). The median age of the pts is 36 years (4 - 58), the Sex ratio is 1,42 (20M/14F). Median time from diagnosis to allogeneic HSCT was 11 months (2-81). The pre-transplant status of pts according to the WHO 2016 classification is (MDS with unilineage dysplasia: 4 including 2 with ring sideroblasts and 1 with isolated del 5q, MDS with multilineage dysplasia: 30 including 07 with excess blasts-1 and 09 with excess blasts -2). The treatments received before the transplant are: Ciclosporin: 07 pts, EPO: 07 pts, Danazol: 03 pts, Revlimid: 02 pts, Azacytidine: 01 pt, Aracytine: 01 pt, Rituximab: 01 pt and 33 pts were transfusion-dependent before the graft with an average of 32 RBC unit/ pt (3 - 135). All the patients received myeloablative conditioning [classic MAC: 13 pts (Santos, TUTSHKA, Haplo); Flu-Bu4: 21 pts]. GVHD prophylaxis consisted on association of Cyclosporin and Methotrexate according to the Seattle protocol in 31 pts of which 10 pts received anti thymocyte globulin; Post-transplant Endoxan and Mycophenolate mofetil without Methotrexate for 3 pts. All pts received G-CSF alone mobilised peripheral blood stem cells, with a median CD34+ cell count: 7,62.106 / kg (3.18-19.9). In addition to the CSP graft, one patient received a bone marrow graft.
Results
Neutropenia occured in all pts and the median duration of aplasia was14 (7-31) days. Median time to achieve neutrophils count > 0,5.109/l: 14 days (11-25) and platelets > 20.109/l: 13 days (9-35). Thirty pts (88%) required red blood cells transfusion (8.7 unit/pt) and 31 pts (91%) needed platelet transfusions (6.6 units/pt). Three pts (8.8%) presented VOD, one of which was severe. Grade II-IV acute GVHD was observed in 08/26 pts (30.7%) and chronic GVHD in 11/20 pts (55%) of whom 5 with an extensive form. Relapse was observed in 2/26 pts (7.6%) within 4 and 20 months post transplant. At July 31, 2020, the median follow-up is 94.5 months (16-202), 16 pts (47%) are still alive (15 pts in complete remission and 1 pts in relapse on Azacytidine), 18 pts (53%) are died including 17 pts (50%) of TRM (early infection: 06, VOD: 01, thrombotic microangiopathy: 1, acute GVHD: 04, pneumopathy: 02, fulminant hepatitis: 01, metabolic disorders: 02) and 1 pt of relapse . The overall survival (OS) is 47%, relapse-free survival (EFS) 44%, and GVHD-free and relapse-free survival (GRFS) 32%.
Conclusion
Allogeneic HSCT, in our study, was a curative option in 44% of patients with MDS with 16 years of follow-up. Thirty-two% are alive with a good quality of life.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Long-term follow-up, Myelodysplasia