Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology, University Medical Center Ljubljana, Ljubljana, Slovenia.
Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Biol Blood Marrow Transplant. 2020 Nov;26(11):2047-2052. doi: 10.1016/j.bbmt.2020.07.018. Epub 2020 Jul 24.
The indication for allogeneic stem cell transplantation (SCT) in patients with lower-risk myelodysplastic syndrome (MDS) is controversial. Here we report 60 patients with a low risk (n = 32) or intermediate risk (n = 28) classification according to the revised International Prognostic Scoring System (IPSS-R) who underwent allogeneic SCT with a reduced-intensity conditioning (n = 45) or myeloablative conditioning (n = 15) regimen from an HLA-identical sibling (n = 9), a matched unrelated donor (n = 36), or a mismatched unrelated donor (n = 15). The rates of grade II-IV and grade III-IV acute graft-versus-host disease were 32% and 7%, respectively, resulting in a transplantation-related mortality (TRM) of 17% at 3 years. The cumulative incidence of relapse at 5 years was only 7%, resulting in a 5-year disease-free survival of 72% and overall survival (OS) of 79%. Transplantation from a fully matched donor resulted in significantly improved OS at 5 years (91% versus 70%). Allogeneic SCT in lower-risk MDS (IPSS-R low or intermediate risk) from an HLA-matched donor resulted in excellent OS with a low risk of relapse.
异基因造血干细胞移植（SCT）在低危骨髓增生异常综合征（MDS）患者中的适应证存在争议。我们在此报告了 60 例低危（n=32）或中危（n=28）根据修订后的国际预后评分系统（IPSS-R）分类的患者，他们接受了异基因 SCT，预处理方案为低强度（n=45）或清髓性（n=15），供者为 HLA 匹配的同胞（n=9）、匹配的无关供者（n=36）或不匹配的无关供者（n=15）。Ⅱ-Ⅳ级和Ⅲ-Ⅳ级急性移植物抗宿主病的发生率分别为 32%和 7%，导致 3 年时移植相关死亡率（TRM）为 17%。5 年时复发的累积发生率仅为 7%，导致 5 年无病生存率为 72%和总生存率（OS）为 79%。来自完全匹配供者的移植可显著改善 5 年 OS（91% vs. 70%）。来自 HLA 匹配供者的低危 MDS（IPSS-R 低危或中危）患者进行异基因 SCT 可获得极好的 OS 且复发风险低。
