Abstract
The optimal conditioning regimen for high-risk myelodysplastic syndrome (MDS) patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains elusive. This study aimed to explore the anti-leukemic efficacy and toxicity of Decitabine (Dec, 20 mg/m2/day, day −11 to −7) intensified BUCY2 vs. traditional regimen in high-risk MDS population. We retrospectively evaluated 93 consecutive high-risk MDS patients undergoing allo-HSCT in our institution, comparing discrepancies in clinical characteristics and outcomes between cases using Dec-intensified BUCY2 (n = 52) and traditional BUCY2 regimen (n = 41). Three-year cumulative incidence of relapse after Dec-intensified BUCY2 conditioning was remarkably lower than that of patients using BUCY2 regimen (20.2% vs. 39.0%, p = 0.034). Overall survival and disease-free survival at 3 years for Dec-intensified BUCY2 group were 70.2% and 64.9%, respectively, which were significantly improved when compared with BUCY2 group (51.1% and 43.9%, p = 0.031 and p = 0.027). Furthermore, overall survival and disease-free survival for MDS cases receiving cytoreduction therapy were dramatically better than patients in non-cytoreduction group (p = 0.041, p = 0.047). In summary, the Dec-intensified conditioning regimen could be effective and feasible, providing prominent recurrence control with moderate toxicity for high-risk MDS patients. These patients might also benefit from pre-transplant cytoreductive therapeutic schedules. Larger randomized controlled trials are still needed to further confirm these conclusions.
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Acknowledgements
The present work was supported and funded by the National Natural Science Foundation of China (Nos. 81974003, 81900181, 81370668), Key Scientific Research Project of Henan University (No. 20A320021) and Collaborative Innovation Center of Hematology of China.
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L-HX and WS conceived the protocol; RZ analyzed, interpreted the data and wrote the manuscript; XL, LVT and HY carried out the statistical analysis; H-FW, YY and Z-DZ revised the manuscript, and all authors critically reviewed and approved the final version of the manuscript.
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Zhang, R., Lu, X., Tang, L.V. et al. Comparative analysis of Decitabine intensified BUCY2 and BUCY2 conditioning regimen for high-risk MDS patients undergoing allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 57, 1063–1071 (2022). https://doi.org/10.1038/s41409-022-01645-2
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DOI: https://doi.org/10.1038/s41409-022-01645-2