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Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (MDS): A Single Center Experience
HSCT is the only potentially curative therapy for a well-selected group of patients with MDS. The objective of this work was to describe a single center experience over the past 15 years with HSCT in MDS patients.
Materials and Methods: Retrospective descriptive.
Patients
From 1997 to May 2013, 19 transplants have been performed in 18 patients. 11 were male; mean age was 45 years (range 31-62).
11 patients had marrow failure as predominantly clinical presentation; only one of these patients had not had multiple transfusions at the time of transplantation. 5 patients were in first complete remission after induction chemotherapy. Only 3 patients received hypomethylating therapy before transplantation. Median time from diagnosis to transplant was 296 days (range 58-950).
Results
PBSC from HLA identical sibling donors where use in 18 transplants. One patient received PBSC from an HLA identical URD. Conditioning treatment consisted on Fludarabine-PO Busulfán (11) or PO Busulfan-Cyclosphosphamide (4) in the majority of patients. GVHD prophylaxis was performed with Cyclosporine-MMF(10) or Cyclosporine-MTX (5) in most cases.
17 patients engrafted; one patient had a primary graft failure, which was rescued with a second transplant from the same donor that also failed.
Mean CD34+ infused were 3.5 (range 1.05-4.64), mean neutrophil graft was on day +12 (range 10-16),
4 patients (22 %) died before day 100 (graft failure, alveolar hemorrhage, relapse, liver failure). 3 patients died after the 100th day, all in relation to GVHD. With a median follow up of 24.1 months (range: 0.7-89.1), overall survival was 61 %. GVHD was the most frequent cause of death. 5 of the 7 deaths occurred in the first year.
Conclusion: The HSCT is a curative strategy for a significant percentage of patients with MDS.