| Objective:To analyze and compare the efficacy and safety of allogeneic hematopoietic stem cell transplantation(allo-HSCT)with conditioning regimen containing decitabine to the conventional conditioning regimen in the treatment of myelodysplastic syndromes(MDS)and MDS transformed acute myeloid leukemia(MDS-AML).Methods:This was a single-center,retrospective analysis of 170 patients with MDS or MDS-AML who underwent allo-HSCT between February 2002 and September 2017.Patients were divided into two groups according to conditioning regimen.110 patients received conventional conditioning regimen(conventional group).60 patients received decitabine combined with conventional conditioning regimen(decitabine group).We primarily evaluated post-transplantation hematopoietic reconstruction,cumulative incidence of overall survival(OS),disease-free survival(DFS),relapse rate(RR),transplant-related mortality(TRM),acute graft-versus-host-disease(aGVHD)and chronic graft-versus-host-disease(cGVHD)between the conventional group and the decitabine group.For 136 cases of patients with high-risk,very high-risk MDS and MDS-AML,we performed a subgroup analysis of 82 patients receiving conventional conditioning regimen prior to allo-HSCT and 54 patients receiving combined conditioning regimen containing decitabine prior to allo-HSCT in terms of post-transplantation cumulative incidence of OS,DFS,RR,TRM,a GVHD and cGVHD.Results:Neutrophils exceeding 0.5×10~9/L and platelets exceeding50×10~9/L were at post-transplantation 10-24 days(median 14 days)and 1-113days(median 19 days)in the decitabine group,10-32 days(median 14 days)and 5-395 days(median 22 days)in the conventional group,respectively.No significant difference was observed in the engraftment of neutrophils and platelets(P>0.05).The median follow-up time was 16.6 months(range0.1-58.8months)and 32.6 months(range 0.1-171.4months)in the decitabine group and the conventional group,respectively.The 3-year OS,3-year DFS,3-year RR,100-day TRM were 63.9%and 55.7%,60.8%and 46.9%,13.3%and28.8%,27.1%and 31.1%in the decitabine group and the conventional group,respectively.However,there was no statistically significant difference in terms of OS,DFS,RR and TRM in the two groups.The cumulative incidence of gradeⅡ-ⅣaGVHD by the day 30 and by the day 100 were significantly lower in the decitabine group(28.8%vs.44.5%,P=0.042;30.6%vs.45.8%,P=0.038,respectively),compared with that in the conventional group.However,the cumulative incidence of post-transplantation 30-day gradeⅢ-ⅣaGVHD(19%vs.24.6%,P=0.393),100-day gradeⅢ-ⅣaGVHD(20.9%vs.25.8%,P=0.350),2-year cGVHD(56.2%vs.62.5%,P=0.409),2-year extensive cGVHD(43.4%vs.47.6%,P=0.399)were similarly in the decitabine group and the conventional group.Multivariate analysis demonstrated that the conditioning regimen containing decitabine was an independent factor preventing the occurrence of gradeⅡ-ⅣaGVHD after transplantation(HR:0.501,P=0.042).A subgroup analysis of patients with high-risk,very high-risk MDS and MDS-AML showed that 3-year OS and 3-year DFS in the decitabine group were slightly higher than in the conventional group,and the cumulative incidence of 3-year RR,100-day TRM,30-day and 100-day gradeⅢ-Ⅳa GVHD,30-day and 100-day gradeⅢ-ⅣaGVHD,2-year cGVHD and 2-year extensive cGVHD in the decitabine group were lower than in the conventional group,but it was only the cumulative incidence of 30-day and 100-day gradeⅢ-ⅣaGVHD that had a significant difference between the two groups(P=0.014,P=0.012,respectively).Conclusion:Allo-HSCT is an effective treatment of for MDS and MDS-AML.The conditioning regimen containing decitabine prior to allo-HSCT is feasible and shows good tolerance,and significantly reduces the occurrence of gradeⅡ-Ⅳacute GVHD after transplantation.However,there is no significant effect on chronic GVHD.In the meantime,it has the tendency to improve OS,DFS and reduces relapse without increasing early post-transplantation TRM.Additionally,the conditioning regimen containing decitabine is also safe and effective for relatively high-risk MDS and MDS-AML. |
