Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel Journal Article

Authors: de Witte, T.; Bowen, D.; Robin, M.; Malcovati, L.; Niederwieser, D.; Yakoub-Agha, I.; Mufti, G. J.; Fenaux, P.; Sanz, G.; Martino, R.; Alessandrino, E. P.; Onida, F.; Symeonidis, A.; Passweg, J.; Kobbe, G.; Ganser, A.; Platzbecker, U.; Finke, J.; van Gelder, M.; van de Loosdrecht, A. A.; Ljungman, P.; Stauder, R.; Volin, L.; Deeg, H. J.; Cutler, C.; Saber, W.; Champlin, R.; Giralt, S.; Anasetti, C.; Kroger, N.
Article Title: Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel
Abstract: An international expert panel, active within the European Society for Blood and Marrow Transplantation, European Leukemia Net, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronicmyelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-Randthose with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, andhigh IPSS-R score have a low chance of curewith standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with >='10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.
Keywords: leukemia; chronic; system; bone-marrow-transplantation; acute myeloid-leukemia; prognostic scoring; acute myelogenous; myelomonocytic leukemia; graft-versus-leukemia; risk myelodysplastic syndrome; monosomal karyotype; identical sibling donors; somatic mutations identify
Journal Title: Blood
Volume: 129
Issue: 13
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2017-03-30
Start Page: 1753
End Page: 1762
Language: English
ACCESSION: WOS:000397776800007
DOI: 10.1182/blood-2016-06-724500
PUBMED: 28096091
PMCID: PMC5524528
Notes: Review -- Source: Wos
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MSK Authors
  1. Sergio Andres Giralt
    516 Giralt