The impact of granulocyte colony-stimulating factor and decitabine-containing conditioning in myelodysplastic syndrome patients with iron overload undergoing allogeneic hematopoietic stem cell transplantation: a retrospective study.

BACKGROUND

Iron overload is considered an unfavorable prognosis in myelodysplastic syndrome (MDS) even in those undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although iron chelation therapy has improved the prognosis of these patients to some extent, the effect has not yet been satisfactory.

OBJECTIVES

This study aimed to investigate the impact of granulocyte colony-stimulating factor and decitabine (G-DAC)-containing conditioning in iron-overloaded MDS patients undergoing allo-HSCT.

DESIGN

This was a retrospective study.

METHODS

One hundred and ninety-seven patients were enrolled in this retrospective study. Based on the level of serum ferritin (SF) and conditioning regimen, all patients enrolled were divided into four groups: SF < 1000 µg/L with G-DAC conditioning (cohort 1), SF < 1000 µg/L with non-G-DAC conditioning (cohort 2), SF ⩾ 1000 µg/L with G-DAC conditioning (cohort 3), and SF ⩾ 1000 µg/L with non-G-DAC conditioning (cohort 4). The clinical features and prognosis of the four groups were analyzed.

RESULTS

Significant differences in the 2-year overall survival (OS), disease-free survival (DFS), and the cumulative incidence of non-relapse mortality (NRM) were observed between the four groups. Multivariate analysis revealed that SF ⩾ 1000 µg/L was a risk factor for OS, DFS, and NRM while G-DAC-containing conditioning was a protective factor. Intriguingly, when cohort 1 to cohort 4 were included in the multivariate analysis, only cohort 4 was a risk factor for OS, DFS, and NRM, cohort 3 had no difference in prognosis compared with patients with SF < 1000 µg/L.

CONCLUSION

The poor prognosis of patients with iron overload may be overcome by G-DAC-containing conditioning partly.