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Favorable outcomes in MDS and oligoblastic AML-MR after reduced-intensity conditioning allogeneic bone marrow transplantation with post-transplantation cyclophosphamide

Bone Marrow Transplantation (2024)Cite this article

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In the most recent World Health Organization classification and International Consensus Classification in 2022, high-risk myelodysplastic syndrome (MDS) and acute myeloid leukemia myelodysplasia-related (AML-MR) are viewed as a biologic continuum [1, 2]. Disease progression and risk assessment are not solely explained by a blast-oriented classification, which lacks a biological basis, and increasingly, molecular characterization is considered [3, 4].

The only potential path to cure patients with these entities has long been allogeneic bone marrow transplantation (Allo-BMT) [5, 6]. The incorporation of post-transplantation cyclophosphamide (PTCy) into reduced intensity conditioning (RIC) or non-myeloablative (NMA) Allo-BMT protocols has demonstrated superior efficacy in minimizing cumulative incidence (CuI) of graft-versus-host disease (GVHD), but understandable concerns about relapse rates have been raised in both MDS and AML-MR (ref. [7, 8]). In this study, we analyze the long-term outcomes of Allo-BMT with PTCy recipients across the high-risk MDS and oligoblastic AML-MR spectrum, emphasizing the prognostic implications of molecular profiling.

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Fig. 1: Outcomes of MDS and oligoblastic AML-MR patients who underwent reduced-intensity conditioning Allo-BMT with PTCy.

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Author notes

  1. These authors contributed equally: Amy E. DeZern, Theodoros Karantanos.

Authors and Affiliations

  1. Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA

    Ilias Sinanidis, Brandon Bonilla, Alexander J. Ambinder, Richard J. Jones, Amy E. DeZern & Theodoros Karantanos

  2. Division of Hematology, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Michael J. Hochman

  3. Division of Quantitative Sciences, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA

    Hua-Ling Tsai & Ravi Varadhan

  4. Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA, USA

    Michael P. Randall

Authors
  1. Ilias Sinanidis
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  4. Michael P. Randall
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  5. Brandon Bonilla
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  8. Richard J. Jones
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Contributions

IS was responsible for designing the study, extracting clinical data, interpreting results, writing and editing the manuscript (except for the statistical analysis section of methods), making the reference list, designing the figure, and writing supplementary materials (Supplementary Tables and Figure). MH was responsible for extracting clinical data, interpreting results, and manuscript editing. HT conducted the statistical analysis and contributed to interpreting results, writing the statistical analysis section of methods and figure, supplementary tables and manuscript editing. MPR and BB were responsible for extracting clinical data. RV conducted the statistical analysis and interpreted the results. AA and RJ provided clinical data and feedback and edited the manuscript. AED and TK conceived and designed the study, collected clinical data, interpreted the results, wrote, and edited the manuscript, and supervised the project.

Corresponding authors

Correspondence to Amy E. DeZern or Theodoros Karantanos.

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Sinanidis, I., Hochman, M.J., Tsai, HL. et al. Favorable outcomes in MDS and oligoblastic AML-MR after reduced-intensity conditioning allogeneic bone marrow transplantation with post-transplantation cyclophosphamide. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02299-y

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