The Clinical Analysis Of Allogeneic Hematopoietic Stem Cell Transplantation In Myelodysplastic Syndrome

Objective:To evaluate the curative effect of allogeneic hematopoietic stem cell transplantation(allo-HSCT) in patients with myelodysplastic syndromes (MDS), to explore prognostic factors predicting long-term outcomes, and to discuss the indications and timing of receiving this treatment.Method:We performed a retrospective analysis of 69 MDS and MDS/AML patients who received transplantation from 1999.6 to 2015.10 in The First Affiliated Hospital of Zhejiang University. Describing their clinical characteristics and long-term survival, analyse the influence of factors including recipient age, gender, course of disease, disease status, treatment before transplantation,donor source, transfusion dependence, acute graft versus host disease(aGVHD), chronic graft versus host disease(cGVHD) to the overall survival(OS) and disease-free survival (DFS), and finding the potential independent factors predicting the outcomes of allo-HSCT, then discussing the indications and timing of MDS in order to receive this treatment.Results:A total of 69 patients received allo-HSCT, the median follow-up time is 48.2(198.8—1.8) months.65 patients achieved sustained myeloid engraftment, and the median engraftment time of ANC is 12(11—16) days,the median engraftment time of PLT is 14 (12—17.5) days.2 patients died in the bone marrow depressed period,2 patients has primary implant failure.41 patients occurred aGVHD, the median time is 14 (11-18.25) days, The cumulative incidence of grade Ⅱ-Ⅳ aGVHD was 34.8%, The cumulative incidence of grade Ⅲ-Ⅳ aGVHD was 20.3%. The 3-year cumulative incidence of cGVHD was 65.2%. The 3-year estimated overall survival(OS) and disease-free survival(DFS) rates were 58.4% and 58.0% respectively. The cumulative relapse rate(RR) and non-relapse mortality(NRM) was 7.2% and 36.2% respectively. The 3-year OS and DFS of identical-sibling donors HSCT is 78.3% and 78.8%, notably higher than 50.7%(p=0.035) and 49.4%(p=0.026) of haploidentical donor transplantation, higher than 54.5%(p=0.182) and 54.5%(p=0.217) of unrelated donor, and there is no statistically significant difference between haploidentical donor and unrelated donor (p=0.402, p=0.279)。 The 3-year OS and DFS of IPSS "low/Intermediate-1" patients is 58.0% and 56.8%; "Intermediate-2/high" is 65.4% and 65.4% respectively, with no statistically significant difference between them (p=0.709, p=0.541). Univariate analysis showed that status of WPSS, donor source, aGVHD, and cGVHD were the prognostic factors to the 3-year OS and DFS. To "Intermediate-2/high" patients, the comorbidity and transfusion dependence are the risk factors of 3-year OS and DFS; and recipient age, gender, course of disease, iron protein level, blast cell proportion, donor gender, recipient-donor blood type, chromosome abnormality, graft type have no notable influence on 3-year OS and DFS of MDS patients after all-HSCT. Multivariate analyses showed non cGVHD was the independent variable associated with the 3-year OS and DFS.Conclusion:Allo—HSCT remains a potential curative therapeutic option for patients with MDS. HLA-identical sibling donors has the best outcome, there is no statistically significant difference between haploidentical donor and unrelated donor. For those MDS patients which has intermediate/high risk and tolerance to allo-HSCT, all-HSCT is the first choice of treatment, and HLA-identical sibling donor is the best, if lacing, haploidentical donor and unrelated donor are feasible choices. No cGVHD was associated with an decreased 3-year OS and DFS.