[en] Allogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2-4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32-1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28-1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome.
Disciplines :
Hematology
Author, co-author :
Michel, Claire; Hematology department, University hospital of Nancy, Nancy, France
Robin, Marie ; Hematology department, Hôpital Saint-Louis, Paris, France
Morisset, Stephane; Biostatistics Consultant, Pérouges, France
Blaise, Didier ; Hematology department, Institut Paoli Calmette, Marseille, France
Maertens, Johan; Hematology department, Hôpital UZ Leuven, Louvain, Belgium
Chevalier, Patrice; Hematology department, University hospital of Nantes, Nantes, France
Castilla-Llorente, Cristina; Hematology department, Institut Gustave Roussy, Paris, France
Forcade, Edouard ; Hematology department, Hôpital Haut-Levêque, Bordeaux, France
Ceballos, Patrice; Hematology department, Hôpital Saint Eloi, Montpellier, France
Yakoug-Agha, Ibrahim ; Hematology department, CHU de Lille, Univ Lille, INSERM U1286, Infinite, Lille, France
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