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Myelodysplasias

Allogeneic stem cell transplantation for older advanced MDS patients: improved survival with young unrelated donor in comparison with HLA-identical siblings

Leukemia volume 27, pages 604–609 (2013)Cite this article

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Abstract

We investigated whether a young human leukocyte antigen (HLA)-matched unrelated donor (MUD) should be preferred as donor to an HLA-identical sibling (MRD) for older patients with myelodysplastic syndrome (MDS) (⩾50 years) who underwent allogeneic stem cell transplantation (AHSCT). Outcomes of 719 MDS patients with a median age of 58 years (range, 50–73 years) who received AHSCT from related (n=555) or unrelated (n=164) donors between 1999 and 2008 and reported to the European Group for Blood and Marrow Transplantation were analyzed. The median donor age of the MRD was 56 years (range: 35–78), in contrast to 34 years (range: 19–64) for the MUDs. Influence of donor’s age on survival was not observed for MRD (hazard ratio (HR): 1.01 (95% confidence interval (CI): 0.99–1.02), P=0.2), but there was a significant impact of MUD’s age on outcome (HR: 1.03 (95% CI: 1.01–1.06); P=0.02). Transplantation from younger MUDs (<30 years) had a significant improved 5-year overall survival in comparison with MRD and older MUDs (>30 years): 40% vs 33% vs 24% (P=0.04). In a multivariate analysis, AHSCT from young MUD (<30 years) remained a significant factor for improved survival in comparison with MRD (HR: 0.65 (95% CI: 0.45–0.95), P=0.03), which should be considered in donor selection for older patients.

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Authors and Affiliations

  1. Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    N Kröger, T Zabelina & H Alchalby

  2. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

    L de Wreede & A van Biezen

  3. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    J Berger

  4. CHU Bordeaux, Hopital Haut-leveque, Pessac, France

    N Milpied

  5. Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

    L Volin

  6. Department of Hematology, CHU Nantes, Nantes, France

    M Mohty

  7. Department of Hematology, Groupe Hospitalier Pitié-Salpetriere, Paris, France

    V Leblond

  8. Unité de transplantation et thérapie cellulaire, Institut Paoli Calmettes, Marseille, France

    D Blaise

  9. Department of Medicine-Hematology and Oncology, University of Freiburg, Freiburg, Germany

    J Finke

  10. Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands

    N Schaap

  11. Department of Hematology-BMT, Hopital St Louis, Paris, France

    M Robin

  12. Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands

    T de Witte

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  1. N Kröger
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  2. T Zabelina
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  10. V Leblond
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  11. D Blaise
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  12. J Finke
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  14. M Robin
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  15. T de Witte
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on behalf of the MDS subcommittee of the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

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Correspondence to N Kröger.

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The authors declare no conflict of interest.

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Author contributions

NK designed the study, analyzed, interpreted data and wrote the manuscript. TZ, LdW and JB performed statistical analysis, HA and AvB collected patients data. NM, LV, MM, VL, DB, JF, NS, MR contributed patients data. TdW wrote the manuscript. All authors approved the final version of the manuscript.

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Kröger, N., Zabelina, T., de Wreede, L. et al. Allogeneic stem cell transplantation for older advanced MDS patients: improved survival with young unrelated donor in comparison with HLA-identical siblings. Leukemia 27, 604–609 (2013). https://doi.org/10.1038/leu.2012.210

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