Oncotarget

Clinical Research Papers:

Better transplant outcome with pre-transplant marrow response after hypomethylating treatment in higher-risk MDS with excess blasts

Seung-Ah Yahng, Myungshin Kim, Tae-Min Kim, Young-Woo Jeon, Jae-Ho Yoon, Seung-Hwan Shin, Sung-Eun Lee, Ki-Seong Eom, Seok Lee, Chang-Ki Min, Hee-Je Kim, Dong-Wook Kim, Jong-Wook Lee, Woo-Sung Min and Yoo-Jin Kim _

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Oncotarget. 2017; 8:12342-12354. https://doi.org/10.18632/oncotarget.12511

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Abstract

Seung-Ah Yahng1, Myungshin Kim2,3, Tae-Min Kim4, Young-Woo Jeon5, Jae-Ho Yoon5, Seung-Hwan Shin6, Sung-Eun Lee5, Ki-Seong Eom3,5, Seok Lee3,5, Chang-Ki Min3,5, Hee-Je Kim3,5, Dong-Wook Kim3,5, Jong-Wook Lee5, Woo-Sung Min5 and Yoo-Jin Kim3,5

1 Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

2 Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

3 Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea

4 Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea

5 Catholic Blood and Marrow Transplantation Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

6 Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to:

Yoo-Jin Kim, email:

Keywords: higher-risk myelodysplastic syndrome, marrow response, hypomethylating treatment, allogeneic hematopoietic stem cell transplantation

Received: February 09, 2016 Accepted: October 01, 2016 Published: October 06, 2016

Abstract

Hypomethylating treatment (HMT) has been suggested as a feasible bridge to hematopoietic stem cell transplantation (HSCT), but controversies exist around influences of HMT response on transplant outcomes. To assess the safety and influences of pre-transplant HMT focusing on debulking effects and transplant outcomes, we retrospectively analyzed consecutive HSCT-eligible patients who received HMT for higher-risk MDS with excess blasts. Of all 98 patients, 11 patients failed to proceed to HSCT and HMT-related mortality occurred in 8 patients. When excluding 9 patients who refused HSCT, 87% of scheduled HSCT (77 of 89) was performed after a median of 3 cycles (range, 1-8) of HMT. The 4-year overall survival after HMT (n = 98) and HSCT (n = 77) was 44.0% and 53.6%, respectively. Transplant outcomes were significantly different by the final response at HSCT; marrow response group (complete remission, marrow complete remission with or without hematologic improvement) showed significantly better 4-year disease-free survival compared to no marrow response group (n = 36, 87.3% vs. n = 41, 10.7%, P < 0.001). This difference between the groups was also evident in overall survival (90.9% vs. 8.6%, P < 0.001) and cumulative incidences of relapse (6.5% vs. 45.4%, P < 0.001) and treatment-related mortality (6.2% vs. 43.9%, P < 0.001). These observations indicate that pre-transplant HMT is a feasible bridging treatment in patients with excess blasts regarding high success rate of proceeding to transplantation and good survival rate. Marrow response at HSCT regardless of concomitant hematological improvement is an independent predictor of better survival, suggesting that immediate HSCT rather than continuing HMT should be performed once marrow response is achieved.


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