Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Manuscript
  • Published:

MDS

Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome

Leukemia volume 19, pages 396–401 (2005)Cite this article

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a curative treatment for myelodysplastic syndrome (MDS). The object of this study was to evaluate the impact of chemotherapy before allo-SCT. We analyzed the data of 283 patients who underwent allo-SCT from an HLA-identical sibling donor for MDS that were reported to the Japan Society for Hematopoietic Cell Transplantation. The cumulative incidence of grade II–IV acute GVHD was 33%. Overall survival (OS) at 5 and 10 years was 48.8 and 42.5%, respectively. Multivariate analyses identified karyotype, FAB classification, and the history of chemotherapy before allo-SCT as significant predictors for OS. OS at 5 years was 57% for patients who underwent allo-SCT as a primary treatment for refractory anemia with excess blasts in transformation (RAEB-t) or secondary acute myeloid leukemia (AML) and 54% for those who underwent allo-SCT in remission after induction chemotherapy (P=0.81). The proportion of patients with a poor karyotype was equivalent between the two groups (P=0.44). Although only a randomized controlled trial will be able to establish a definite conclusion, these results do not support the administration of induction chemotherapy for patients with RAEB-t or secondary AML before allo-SCT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Castro-Malaspina H, Harris RE, Gajewski J, Ramsay N, Collins R, Dharan B et al. Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood 2002; 99: 1943–1951.

    Article  CAS  PubMed  Google Scholar 

  2. de Witte T, Hermans J, Vossen J, Bacigalupo A, Meloni G, Jacobsen N et al. Haematopoietic stem cell transplantation for patients with myelo-dysplastic syndromes and secondary acute myeloid leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol 2000; 110: 620–630.

    Article  CAS  PubMed  Google Scholar 

  3. Deeg HJ, Shulman HM, Anderson JE, Bryant EM, Gooley TA, Slattery JT et al. Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age. Blood 2000; 95: 1188–1194.

    CAS  PubMed  Google Scholar 

  4. Sierra J, Perez WS, Rozman C, Carreras E, Klein JP, Rizzo JD et al. Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia. Blood 2002; 100: 1997–2004.

    CAS  PubMed  Google Scholar 

  5. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–2088.

    CAS  PubMed  Google Scholar 

  6. Cutler CS, Lee SJ, Greenberg P, Deeg HJ, Perez WS, Anasetti C et al. A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low risk myelodysplasia is associated with improved outcome. Blood 2004; 104: 579–585.

    Article  CAS  PubMed  Google Scholar 

  7. Anderson JE . Allogeneic transplantation for myelodysplastic and myeloproliferative disorders. In: Blume KG, Forman SJ, Appelbaum FR (eds). Thomas' Hematopoietic Cell Transplantation, 3rd edn. Malden, MA, USA: Blackwell Publishing, 2003, pp 1084–1095.

    Chapter  Google Scholar 

  8. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol 1982; 51: 189–199.

    Article  CAS  PubMed  Google Scholar 

  9. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  10. Estey E, Thall P, Beran M, Kantarjian H, Pierce S, Keating M . Effect of diagnosis (refractory anemia with excess blasts, refractory anemia with excess blasts in transformation, or acute myeloid leukemia [AML]) on outcome of AML-type chemotherapy. Blood 1997; 90: 2969–2977.

    CAS  PubMed  Google Scholar 

  11. Gooley TA, Leisenring W, Crowley J, Storer BE . Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 1999; 18: 695–706.

    Article  CAS  PubMed  Google Scholar 

  12. Wattel E, De Botton S, Luc LJ, Preudhomme C, Lepelley P, Bauters F et al. Long-term follow-up of de novo myelodysplastic syndromes treated with intensive chemotherapy: incidence of long-term survivors and outcome of partial responders. Br J Haematol 1997; 98: 983–991.

    Article  CAS  PubMed  Google Scholar 

  13. Bertz H, Potthoff K, Finke J . Allogeneic stem-cell transplantation from related and unrelated donors in older patients with myeloid leukemia. J Clin Oncol 2003; 21: 1480–1484.

    Article  PubMed  Google Scholar 

  14. Taussig DC, Davies AJ, Cavenagh JD, Oakervee H, Syndercombe-Court D, Kelsey S et al. Durable remissions of myelodysplastic syndrome and acute myeloid leukemia after reduced-intensity allografting. J Clin Oncol 2003; 21: 3060–3065.

    Article  CAS  PubMed  Google Scholar 

  15. Bowen D, Culligan D, Jowitt S, Kelsey S, Mufti G, Oscier D et al. Guidelines for the diagnosis and therapy of adult myelodysplastic syndromes. Br J Haematol 2003; 120: 187–200.

    Article  PubMed  Google Scholar 

  16. Runde V, de Witte T, Arnold R, Gratwohl A, Hermans J, van Biezen A et al. Bone marrow transplantation from HLA-identical siblings as first-line treatment in patients with myelodysplastic syndromes: early transplantation is associated with improved outcome. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1998; 21: 255–261.

    Article  CAS  PubMed  Google Scholar 

  17. Anderson JE, Gooley TA, Schoch G, Anasetti C, Bensinger WI, Clift RA et al. Stem cell transplantation for secondary acute myeloid leukemia: evaluation of transplantation as initial therapy or following induction chemotherapy. Blood 1997; 89: 2578–2585.

    CAS  PubMed  Google Scholar 

  18. Morishima Y, Morishita Y, Tanimoto M, Ohno R, Saito H, Horibe K et al. Low incidence of acute graft-versus-host disease by the administration of methotrexate and cyclosporine in Japanese leukemia patients after bone marrow transplantation from human leukocyte antigen compatible siblings; possible role of genetic homogeneity. The Nagoya Bone Marrow Transplantation Group. Blood 1989; 74: 2252–2256.

    CAS  PubMed  Google Scholar 

  19. Morishima Y, Kodera Y, Hirabayashi N, Tanimoto M, Matsuyama T, Horibe K et al. Low incidence of acute GVHD in patients transplanted with marrow from HLA-A,B,DR-compatible unrelated donors among Japanese. Bone Marrow Transplant 1995; 15: 235–239.

    CAS  PubMed  Google Scholar 

  20. Lin MT, Storer B, Martin PJ, Tseng LH, Gooley T, Chen PJ et al. Relation of an interleukin-10 promoter polymorphism to graft-versus-host disease and survival after hematopoietic-cell transplantation. N Engl J Med 2003; 349: 2201–2210.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. First Department of Internal Medicine, Kansai Medical University, Japan

    K Nakai & S Fukuhara

  2. Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Tokyo, Japan

    Y Kanda

  3. Hematology Division, Tokyo Metropolitan Komagome Hospital, Japan

    H Sakamaki

  4. Division of Hematology, Keio University School of Medicine, Japan

    S Okamoto

  5. Japanese Red Cross Nagoya First Hospital, Japan

    Y Kodera

  6. National Cancer Center Hospital, Japan

    R Tanosaki

  7. Department of Hematology/Oncology, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    S Takahashi

  8. Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Japan

    T Matsushima

  9. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Japan

    Y Atsuta & N Hamajima

  10. Sapporo Hokuyu Hospital, Japan

    M Kasai

  11. Tokai University School of Medicine, Japan

    S Kato

Authors
  1. K Nakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y Kanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S Fukuhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H Sakamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y Kodera
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Tanosaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. T Matsushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Y Atsuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. N Hamajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M Kasai
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. S Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y Kanda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakai, K., Kanda, Y., Fukuhara, S. et al. Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome. Leukemia 19, 396–401 (2005). https://doi.org/10.1038/sj.leu.2403640

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2403640

Keywords

This article is cited by

Search

Advanced search

Quick links