Zhou Jin-yi, He Guang-sheng, Wu De-pei, Sun Ai-ning, Qiu Hui-ying, Jin Zheng-ming, Tang Xiao-wen, Han Yue, Fu Zheng-zheng, Ma Xiao, Miao Miao, Xue Sheng-li, Wang Ying
Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou 215006, China.
Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou 215006, China. Email:
Zhonghua Yi Xue Za Zhi. 2013 Oct 29;93(40):3185-8.
To explore the impact of prior-to-transplantation induction therapy (IT) on patient outcome after allogeneic hematopoietic stem-cell transplantation (Allo-HSCT) for higher-risk myelodysplastic syndromes (MDS).
A total of 49 consecutive patients underwent Allo-HSCT for MDS between November 2002 and December 2012. Twenty-six lower-risk MDS cases received supportive therapy (ST). And 17/23 cases of higher-risk MDS received IT prior to transplantation while another 6 only with ST. Their survival, relapse rate and incidence of transplantation-related mortality (TRM) were retrospectively analyzed according to International Prognostic Scoring System (IPSS) scores and marrow blast count.
The 5-year cumulative overall survival (OS), disease-free survival (DFS), relapse rate and incidence of transplantation related mortality (TRM) were 59.9%, 59.2%, 10.5% and 31.8% during a median follow-up period of 24.4 (6.2-72.0) months. The OS and DFS of higher-risk group with IT, ST and lower-risk group were different (72.1% vs 16.7% vs 68.1%, P = 0.028; 72.1% vs 16.7% vs 67.9%, P = 0.030). And the OS and DFS of higher-risk group with IT were similar to those of lower-risk group (P = 0.526,0.504) . For the higher-risk group, the patients on IT had improved survival than those on ST in terms of OS and DFS (both P = 0.020). Moreover, the OS and DFS of remission group were higher than non-remission group in patients on IT (both 100% vs 46.7%, P = 0.049). The number of marrow blasts significantly decreased after IT (P = 0.010) without increased TRM (28.9% vs 33.6%, P = 0.612).
Induction therapy prior to Allo-HSCT for MDS may reduce clone burden and improve the outcomes of higher-risk MDS without increased TRM.
探讨移植前诱导治疗（IT）对高危骨髓增生异常综合征（MDS）患者异基因造血干细胞移植（Allo-HSCT）后结局的影响。
2002年11月至2012年12月期间，共有49例连续性MDS患者接受了Allo-HSCT。26例低危MDS患者接受支持治疗（ST）。23例高危MDS患者中，17例在移植前接受了IT治疗，另外6例仅接受ST治疗。根据国际预后评分系统（IPSS）评分和骨髓原始细胞计数，对他们的生存率、复发率和移植相关死亡率（TRM）进行回顾性分析。
在中位随访期24.4（6.2 - 72.0）个月期间，5年累积总生存率（OS）、无病生存率（DFS）、复发率和移植相关死亡率分别为59.9%、59.2%、10.5%和31.8%。接受IT、ST治疗的高危组和低危组的OS和DFS存在差异（72.1%对16.7%对68.1%，P = 0.028；72.1%对16.7%对67.9%，P = 0.030）。接受IT治疗的高危组的OS和DFS与低危组相似（P = 0.526，0.504）。对于高危组，接受IT治疗的患者在OS和DFS方面的生存率高于接受ST治疗的患者（均P = 0.020）。此外，接受IT治疗的患者中，缓解组的OS和DFS高于未缓解组（均为100%对46.7%，P = 0.049）。IT治疗后骨髓原始细胞数量显著减少（P = 0.010），且TRM未增加（28.9%对33.6%，P = 0.612）。
MDS患者Allo-HSCT前的诱导治疗可能降低克隆负荷，改善高危MDS的结局，且不增加TRM。
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