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Prognostic impact of the conditioning intensity on outcomes after allogeneic transplantation for MDS with low blasts: a nationwide retrospective study by the adult MDS working group of the Japan Society for Transplantation and Cellular Therapy

Bone Marrow Transplantation (2024)Cite this article

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Abstract

Poor prognostic factors, such as transfusion dependency and chromosomal risk, need to be considered in the indication of allogeneic hematopoietic cell transplantation (allo-HCT) for patients harboring myelodysplastic syndromes with less than 5% marrow blasts (MDS-Lo). We analyzed the post-transplant outcomes of 1229 MDS-Lo patients who received myeloablative (MAC)(n = 651), reduced-intensity (RIC)(n = 397), and non-myeloablative conditioning (NMAC) regimens (n = 181). The multivariate analysis revealed that the RIC group had better chronic graft-versus-host disease (GVHD)- and relapse-free survival (CRFS) (P = 0.021), and GVHD- and relapse-free survival (GRFS) than the MAC group (P = 0.001), while no significant differences were observed between the NMAC and MAC groups. In the subgroup analysis, the MAC group has better overall survival (P = 0.008) than the RIC group among patients with an HCT-comorbidity index (HCT-CI) score of 0, while the RIC group had better overall survival (P = 0.029) than the MAC group among those with an HCT-CI score ≥3. According to the type of conditioning regimen, total body irradiation 12 Gy-based MAC regimen showed better OS and CRFS than the other MAC regimen, and comparable outcomes to the RIC regimen. In conclusion, the RIC and NMAC regimens are promising options for MDS-Lo patients in addition to the MAC regimen.

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Fig. 1: Backgrounds for the indication of allo-HSCT.
Fig. 2: Adjusted OS, CRFS, GRFS, CIR, and NRM by the conditioning intensity.
Fig. 3: A forest plot of overall mortalities.

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Data availability

All data are available within the article or supplementary files or are available upon request from the corresponding author H.I. (itoman820hide@outlook.jp).

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Acknowledgements

This work was supported in part by the Takeda Science Foundation and a Grant-in-Aid for Scientific Research (KAKENHI) from the Japan Society for the Promotion of Science (22K08480 [Nagasaki; HI]). The authors would like to thank all the physicians and data managers at the various institutes who contributed valuable data on transplantation to the Japanese Society for Transplantation and Cellular Therapy (JSTCT), all the members of the data management committees of JSTCT, and all the members of “Adult Myelodysplastic Syndromes Working Group of the JSTCT”.

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Authors and Affiliations

  1. Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan

    Hidehiro Itonaga

  2. Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan

    Yasushi Miyazaki

  3. Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan

    Yasushi Miyazaki & Machiko Fujioka

  4. Department of Hematology, Sasebo City General Hospital, Sasebo, Japan

    Machiko Fujioka

  5. Department of Hematology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan

    Jun Aoki & Ken Ishiyama

  6. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  7. Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan

    Tetsuya Nishida

  8. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  9. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  10. Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Kurashiki, Japan

    Yasunori Ueda

  11. Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Yasufumi Uehara

  12. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  13. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  14. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  15. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Jun Kato

  16. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  17. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  18. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  19. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  20. Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan

    Yoshiko Atsuta

  21. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

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  1. Hidehiro Itonaga
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  2. Yasushi Miyazaki
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Contributions

HI and YM designed the research, organized the project, and wrote the manuscript. HI, YM, and MF analyzed the data. HI, YM, MF, and KI collected data from TRUMP. HI, YM, MF, JA, ND, TN, TF, NU, YUeda, YUehara, YK, SO, TK, KK, KM, TE, MO, TI, YA, and KI interpreted data and reviewed and approved the final manuscript.

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Correspondence to Hidehiro Itonaga.

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Itonaga, H., Miyazaki, Y., Fujioka, M. et al. Prognostic impact of the conditioning intensity on outcomes after allogeneic transplantation for MDS with low blasts: a nationwide retrospective study by the adult MDS working group of the Japan Society for Transplantation and Cellular Therapy. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02297-0

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