1. ¹Department of Hematology/Oncology, University of Leipzig, Leipzig, Germany
2. ²Department of Medical Statistics, Leiden University MC, Leiden, The Netherlands
3. ³Chronic Leukemia Working Party Registry, Leiden, The Netherlands
4. ⁴Department of Hematology, University of Freiburg, Freiburg, Germany
5. ⁵Department of Hematology, University of Gasthuisberg, Leuven, Belgium
6. ⁶Department of Hematology, Klinik fuer Knochenmarktransplantation GmBH, Idar-Oberstein, Germany
7. ⁷BMT Centre, University Hospital Leiden, Leiden, The Netherlands
8. ⁸Service d' Hematologie, Hospital Jean Minjoz, Besancon, France
9. ⁹Department of Hematology, Charite, Campus Virchow-Klinikum, Berlin, Germany
10. ¹⁰Bone Marrow Transplantation, University of Essen, Essen, Germany
11. ¹¹Department of Hematology, University Medical Center St Radboud, Nijmegen, The Netherlands

Correspondence: Dr HK Al-Ali, Division of Hematology/Oncology, University of Leipzig, Johannissallee 32a, 04103 Leipzig, Germany. E-mail: alah@medizin.uni-leipzig.de

Received 7 January 2007; Revised 20 April 2007; Accepted 23 April 2007; Published online 5 July 2007.

Abstract

Hematopoietic cell transplantation (HCT) is an effective treatment for myelodysplasia (MDS) and secondary acute myeloid leukemia (sAML). In this study, outcome of 593 patients with MDS/sAML after autologous and allogeneic HCT from a matched unrelated donor (MUD) were compared. A total of 167 (28%) patients received HCT from MUD without prior chemotherapy (MUD-U). The rest received HCT in first complete remission (CR1) (Autologous (Auto-CR1), n=290 (49%), HCT from MUD (MUD-CR1), n=136 (23%)). Survival at 3 years was best in MUD-CR1 (50%) compared to Auto-CR1 (41%) and MUD-U (40%) (P=0.01). Similarly, disease-free survival was 44% for MUD-CR1 compared to Auto-CR1 (28%) and MUD-U (34%) (P=0.03). Treatment-related mortality was 17% in Auto-CR1 compared to MUD-CR1 (38%) and MUD-U (49%) (P<0.001). Relapse for Auto-CR1 was 62% compared to 24 and 30% for MUD-CR1 and MUD-U, respectively (P<0.001). Outcome was best for patients with low tumor burden transplanted 6–12 months after diagnosis. Factors influencing outcome at 3 years were mainly significant in the first 6 months. Only, relapse after autologous HCT remained constant over time. Outcomes after allogeneic HCT in patients of 20–40 and >40 years were similar. Autologous and Allogeneic HCT from MUD offer the possibility of long-term survival to patients with MDS/sAML.