Abstract 1707

BACKGROUND:

Treatment of pts with higher-risk MDS revolves around AHSCT and HMA. Although AHSCT is thought to be the only curative approach for pts with MDS, only a small percentage of pts are appropriate candidates and this procedure carries significant morbidity and mortality rates. We wanted to assess outcomes in pts with higher risk MDS treated with AHSCT or HMA. To study this, we performed a retrospective analysis comparing the outcome of pts with previously untreated MDS who received AHSCT or HMA therapy at M.D. Anderson Cancer Center (MDACC).

METHODS:

From a database of pts with MDS who received AHSCT (N=152) at MDACC between 01/1988 and 04/2008, we selected those with untreated MDS prior to receiving the transplant. A total of 53 (29%) pts were identified. We compared them with a control group of 40 pts treated with HMA among 1748 referred to MDACC. All controls were selected to match at least 3 of the following 5 criteria: 1) age, 2) year of diagnosis, 3) percentage of blasts at the time of diagnosis, 4) IPSS cytogenetic risk, and 5) time from diagnosis to treatment. The primary endpoint was survival.

RESULTS:

A total of 53 pts with untreated MDS who received AHSCT and 40 pts treated with HMA were identified (Table 1). Median age was 51 (range 20–62) and 54 (range 38–79) years for pts treated with AHSCT or HMA respectively. There were more pts greater than 60 years old in the HMA group compared to those in the AHSCT group (58% vs. 1% p>0.001). The median follow up time was 64 months. Donors were HLA matched related (n=37), matched unrelated (n=11), 1 antigen mismatched related (n=4) or 1 antigen mismatched unrelated (n=1). Of the 40 pts treated with HMA, 31 were evaluable for response; of those 31, 19 (61%) responded, 16 (52%) achieving a complete response. The median survival was 26 and 25 months for pts receiving AHSCT or HMA, respectively (p=0.41) (Figure 1). The 8-year overall survival rates for pts receiving AHSCT or HMA were 24% and 23% respectively.

Table 1
AHSCTHMAp-value
Age (years) 51 54 <0.001 
Median 20-62 38-79  
Range 23  
Age >60    
Sex 31 23 NS 
Male 22 17  
Female    
IPSS CG 15 10 NS 
Good  
Intermediate 33 26  
Poor    
IPSS BM Blasts 32 22 NS 
<5% 17 15  
5-10%  
11-20%    
Hemoglobin (g/dL) 29 22 NS 
<10 24 18  
>10    
Platelets (x 109/L) 36 29 NS 
>100 17 11  
<100    
WBC (x 109/L) 49 34 NS 
>5  
<5    
Prior malignancies 28 21 NS 
Yes 25 19  
No    
TOTAL 53 40  
AHSCTHMAp-value
Age (years) 51 54 <0.001 
Median 20-62 38-79  
Range 23  
Age >60    
Sex 31 23 NS 
Male 22 17  
Female    
IPSS CG 15 10 NS 
Good  
Intermediate 33 26  
Poor    
IPSS BM Blasts 32 22 NS 
<5% 17 15  
5-10%  
11-20%    
Hemoglobin (g/dL) 29 22 NS 
<10 24 18  
>10    
Platelets (x 109/L) 36 29 NS 
>100 17 11  
<100    
WBC (x 109/L) 49 34 NS 
>5  
<5    
Prior malignancies 28 21 NS 
Yes 25 19  
No    
TOTAL 53 40  
CONCLUSION:

AHSCT did not offer a significant survival improvement in a retrospective analysis of pts with MDS. Treatment with a HMA offers an adequate alternative in older patients or those who cannot tolerate or receive an AHSCT and should be used as a bridge in younger pts who are candidates for AHSCT

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.