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Onida F, Gagelmann N, Chalandon Y, Kobbe G, Robin M, Symeonidis A, de Witte T, Itzykson R, Jentzsch M, Platzbecker U, Santini V, Sanz G, Scheid C, Solary E, Valent P, Greco R, Sanchez-Ortega I, Yakoub-Agha I, Pleyer L. Management of adult patients with CMML undergoing allo-HCT: recommendations from the EBMT PH&G Committee. Blood 2024; 143:2227-2244. [PMID: 38493484 DOI: 10.1182/blood.2023023476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
ABSTRACT Chronic myelomonocytic leukemia (CMML) is a heterogeneous disease presenting with either myeloproliferative or myelodysplastic features. Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only potentially curative option, but the inherent toxicity of this procedure makes the decision to proceed to allo-HCT challenging, particularly because patients with CMML are mostly older and comorbid. Therefore, the decision between a nonintensive treatment approach and allo-HCT represents a delicate balance, especially because prospective randomized studies are lacking and retrospective data in the literature are conflicting. International consensus on the selection of patients and the ideal timing of allo-HCT, specifically in CMML, could not be reached in international recommendations published 6 years ago. Since then, new, CMML-specific data have been published. The European Society for Blood and Marrow Transplantation (EBMT) Practice Harmonization and Guidelines (PH&G) Committee assembled a panel of experts in the field to provide the first best practice recommendations on the role of allo-HCT specifically in CMML. Recommendations were based on the results of an international survey, a comprehensive review of the literature, and expert opinions on the subject, after structured discussion and circulation of recommendations. Algorithms for patient selection, timing of allo-HCT during the course of the disease, pretransplant strategies, allo-HCT modality, as well as posttransplant management for patients with CMML were outlined. The keynote message is, that once a patient has been identified as a transplant candidate, upfront transplantation without prior disease-modifying treatment is preferred to maximize chances of reaching allo-HCT whenever possible, irrespective of bone marrow blast counts.
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Affiliation(s)
- Francesco Onida
- Department of Oncology and Hemato-Oncology, Hematology and Bone Marrow Transplantation Unit, Azienda Socio Sanitaria Territoriale Fatebenefratelli-Sacco, University of Milan, Milan, Italy
- European Society for Blood and Marrow Transplantation Practice Harmonization and Guidelines Committee, Barcelona, Spain
| | - Nico Gagelmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yves Chalandon
- Division of Hematology, University Hospital of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Marie Robin
- Service d'Hématologie Greffe, Hôpital Saint-Louis, L'Assistance Publique-Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Argiris Symeonidis
- Department of Hematology, Olympion General Hospital and Rehabilitation Center, Patras, Greece
| | - Theo de Witte
- Department of Tumor Immunology, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raphael Itzykson
- Université Paris Cité, Génomes, Biologie Cellulaire et Thérapeutique U944, INSERM, Centre National de la Recherche Scientifique, Paris, France
- Département Hématologie et Immunologie, Hôpital Saint-Louis, L'Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Madlen Jentzsch
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Valeria Santini
- Myelodysplastic Syndromes Unit, Hematology, Dipartimento di Medicina Sperimentale e Clinica, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Guillermo Sanz
- University and Polytechnic Hospital La Fe and Health Research Institute La Fe, Valencia, Spain
- Centro de Investigacion Biomedica en Red Cancer, Instituto de Salud Carlos III, Madrid, Spain
| | - Christof Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Eric Solary
- Department of Hematology, INSERM Unité Mixte de Recherche 1287, Gustave Roussy Cancer Center, Villejuif, France
- Université Paris Saclay, Faculty of Medicine, Le Kremlin-Bicetre, France
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Raffaela Greco
- European Society for Blood and Marrow Transplantation Practice Harmonization and Guidelines Committee, Barcelona, Spain
- Unit of Hematology and Bone Marrow Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Isabel Sanchez-Ortega
- European Society for Blood and Marrow Transplantation Practice Harmonization and Guidelines Committee, Barcelona, Spain
| | - Ibrahim Yakoub-Agha
- European Society for Blood and Marrow Transplantation Practice Harmonization and Guidelines Committee, Barcelona, Spain
- Centre Hospitalier Universitaire de Lille, University of Lille, INSERM U1286, Infinite, Lille, France
| | - Lisa Pleyer
- Austrian Group of Medical Tumor Therapy Study Group, Vienna, Austria
- Salzburg Cancer Research Institute, Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
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Liu L, Jia M, Sun L, Tian W, Tang P, Jiang Z. Meta-analysis of the benefit of hypomethylating agents before allogeneic hematopoietic stem cell transplantation in myelodysplastic syndromes. Clin Exp Med 2021; 21:537-543. [PMID: 33866494 PMCID: PMC8505317 DOI: 10.1007/s10238-021-00712-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
Hypomethylating agents (HMAs) are effective therapies in myelodysplastic syndromes (MDS), but allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only way to cure MDS. According to the current literature, it is difficult to confirm whether HMAs bridging therapy is beneficial for MDS patients receiving allo-HSCT. Therefore, we tried to evaluate the effect of HMAs on long-term survival of the MDS patients. Databases, including PubMed, Embase Ovid, and the Cochrane Library, were searched for studies published up to January 10, 2021. Patients who accepted HMAs bridging to allo-HSCT were defined as experimental group, while patients who received the best supportive care (BSC) before allo-HSCT were control group. Overall survival (OS) was the primary end point. Seven studies were included in the final analysis. The final results showed no OS differences between patients accepted HMAs before allo-HSCT and those received BSC (HR = 0.86, 95% CI: 0.64-1.15, p = 0.32), indicating that MDS patients' long-term survival did not benefit from HMAs bridging therapy before allo-HSCT. This conclusion needs to be further verified by a large number of prospective randomized controlled trials, which have guiding significance for the treatment of MDS patients.
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Affiliation(s)
- Liu Liu
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
| | - Menglu Jia
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ling Sun
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Wenliang Tian
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Ping Tang
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Zhongxing Jiang
- Department of Hematology, First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
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Wang H, Li Y, Zhou W, Wang R, Li Y, Yu L. Pre-transplant therapy for patients with myelodysplastic syndromes: A systematic review and meta-analysis. Leuk Res 2021; 110:106645. [PMID: 34217112 DOI: 10.1016/j.leukres.2021.106645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/21/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The value of pre-transplant cytoreductive therapy for patients with myelodysplastic syndromes (MDS) is controversial. Here, we conducted a meta-analysis to explore the effects of cytoreduction before transplantation. METHODS PubMed, Embase, Cochrane, and Chinese databases were searched to identify studies comparing post-transplant outcomes in MDS patients receiving different pre-transplant therapy. Pooled hazard ratios (HRs) and 95 % confidence intervals (CI) were calculated. RESULTS Eighteen reports were included. Post-transplant outcomes were similar for MDS patients receiving pre-transplant cytoreductive therapy and upfront transplantation in terms of overall survival (OS: HR, 0.92; 95 % CI, 0.79-1.07), relapse-free survival (RFS: HR, 1.18; 95 % CI, 0.94-1.47), cumulative incidence of relapse (CIR: HR, 1.08; 95 % CI, 0.88-1.33), and non-relapse mortality (NRM: HR, 0.93; 95 % CI, 0.74-1.18). Pre-transplant hypomethylating agents (HMAs) and chemotherapy were not different regarding post-transplant OS, RFS, CIR, and NRM. Achieving complete remission (CR) before transplantation was associated with increased RFS (HR, 0.80; 95 %CI, 0.63-1.00) and decreased NRM (HR, 0.53; 95 % CI, 0.32-0.90) when compared with upfront transplantation. CONCLUSIONS Timely transplantation is of great value for MDS patients. Suitable pre-transplant cytoreduction could be used during the search for donors.
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Affiliation(s)
- Hong Wang
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China
| | - Yan Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology, Peking University, Third Hospital, Beijing, China
| | - Wei Zhou
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Ruiqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Yonghui Li
- Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China
| | - Li Yu
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China.
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Wang H, Li Y, Xu Q, Zhou W, Yin C, Wang R, Wang M, Xu Y, Li Y, Yu L. Comparison of Upfront Transplantation and Pretransplant Cytoreductive Therapy for Advanced Myelodysplastic Syndrome. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:631-640. [PMID: 34074612 DOI: 10.1016/j.clml.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative therapy for advanced myelodysplastic syndrome (MDS). However, the value of pretransplant cytoreduction remains debatable. PATIENTS AND METHODS We retrospectively compared the outcomes of upfront transplantation and pretransplant cytoreduction. Of 69 patients, 39 received upfront allo-HSCT and 30 received pretransplant cytoreduction, including chemotherapy (n = 16), hypomethylating agents (HMAs, n = 6), and HMAs with chemotherapy (n = 8). RESULTS The upfront group achieved similar overall survival (OS) and a trend of better progression-free survival (PFS) from diagnosis compared with the cytoreduction group (3-year PFS, 64.0% vs. 44.4%, P = .076). Posttransplant outcomes were comparable between the two groups in terms of OS, relapse-free survival (RFS), cumulative incidence of relapse (CIR), and non-relapse mortality (NRM). In patients with ≥2 mutations, the upfront group achieved better OS and PFS (3-year OS, 100.0% vs. 68.6%, P = .044; 3-year PFS: 92.3% vs. 43.9%, P = .016) than the cytoreduction group. Patients achieving remission in the cytoreduction group had outcomes similar to the upfront group, but those without remission before transplantation had a significantly worse posttransplant OS (3-year OS, 46.7% vs. 75.7%, P = .038). Patients with pretransplant HMAs had better PFS than those with chemotherapy or HMAs plus chemotherapy (P < 0.05). CONCLUSION Compared with pretransplant cytoreduction, upfront allo-HSCT might provide more benefit to some patients with advanced MDS if there are suitable donors. HMAs would be a good alternative during the donor search.
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Affiliation(s)
- Hong Wang
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China
| | - Yan Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology, Peking University, Third Hospital, Beijing, China
| | - Qingyu Xu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wei Zhou
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China; Medical Big Data Research Center, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China; National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing, China
| | - Ruiqi Wang
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Mengzhen Wang
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Yuanyuan Xu
- Department of Hematology, Chinese PLA General Hospital, Beijing, China
| | - Yonghui Li
- Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China
| | - Li Yu
- School of Medicine, Nankai University, Tianjin, China; Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China.
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Qin Y, Kuang P, Zeng Q, Wu Y, Liu T. Hypomethylating agents for patients with myelodysplastic syndromes prior to hematopoietic stem cell transplantation: a systematic review and meta-analysis. Ann Hematol 2019; 98:2523-2531. [DOI: 10.1007/s00277-019-03811-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022]
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Sohn SK, Moon JH, Lee IH, Ahn JS, Kim HJ, Chung JS, Shin HJ, Park SW, Lee WS, Lee SM, Kim H, Lee HS, Kim YS, Cho YY, Bae SH, Lee JH, Kim SH, Song IC, Kwon JH, Lee YJ. No benefit of hypomethylating agents compared to supportive care for higher risk myelodysplastic syndrome. Korean J Intern Med 2018; 33:1194-1202. [PMID: 29232940 PMCID: PMC6234402 DOI: 10.3904/kjim.2016.426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/05/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND/AIMS This study evaluated the role of hypomethylating agents (HMA) compared to best supportive care (BSC) for patients with high or very-high (H/VH) risk myelodysplastic syndrome (MDS) according to the Revised International Prognostic Scoring System. METHODS A total of 279 H/VH risk MDS patients registered in the Korean MDS Working Party database were retrospectively analyzed. RESULTS HMA therapy was administered to 205 patients (73.5%), including 31 patients (11.1%) who then received allogeneic hematopoietic cell transplantation (allo-HCT), while 74 patients (26.5%) received BSC or allo-HCT without HMA. The 3-year overall survival (OS) rates were 53.1% ± 10.7% for allo-HCT with HMA, 75% ± 21.7% for allo-HCT without HMA, 17.3% ± 3.6% for HMA, and 20.8% ± 6.9% for BSC groups (p < 0.001). In the multivariate analysis, only allo-HCT was related with favorable OS (hazard ratio [HR], 0.356; p = 0.002), while very poor cytogenetic risk (HR, 5.696; p = 0.042), age ≥ 65 years (HR, 1.578; p = 0.022), Eastern Cooperative Oncology Group performance status (ECOG PS) 2 to 4 (HR, 2.837; p < 0.001), and transformation to acute myeloid leukemia (AML) (HR, 1.901; p = 0.001) all had an adverse effect on OS. CONCLUSION For the H/VH risk group, very poor cytogenetic risk, age ≥ 65 years, ECOG PS 2 to 4, and AML transformation were poor prognostic factors. HMA showed no benefit in terms of OS when compared to BSC. Allo-HCT was the only factor predicting a favorable long-term outcome. The use of HMA therapy did not seem to have an adverse effect on the transplantation outcomes. However, the conclusion of this study should be carefully interpreted and proven by large scale research in the future.
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Affiliation(s)
- Sang Kyun Sohn
- Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea
| | - Joon Ho Moon
- Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea
| | - In Hee Lee
- Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea
| | - Jae Sook Ahn
- Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyeoung Joon Kim
- Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Joo Seop Chung
- Department of Hematology/Oncology, Pusan National University Hospital, Busan, Korea
| | - Ho Jin Shin
- Department of Hematology/Oncology, Pusan National University Hospital, Busan, Korea
| | - Sung Woo Park
- Department of Hematology/Oncology, Pusan National University Hospital, Busan, Korea
| | - Won Sik Lee
- Department of Hematology/Oncology, Inje University Busan Baik Hospital, Busan, Korea
| | - Sang Min Lee
- Department of Hematology/Oncology, Inje University Busan Baik Hospital, Busan, Korea
| | - Hawk Kim
- Department of Hematology/Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Ho Sup Lee
- Department of Hematology/Oncology, Kosin University Gospel Hospital, Busan, Korea
| | - Yang Soo Kim
- Department of Hematology/Oncology, Kosin University Gospel Hospital, Busan, Korea
| | - Yoon Young Cho
- Department of Hematology/Oncology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Sung Hwa Bae
- Department of Hematology/Oncology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Ji Hyun Lee
- Department of Hematology/Oncology, Dong-A University Hospital, Busan, Korea
| | - Sung Hyun Kim
- Department of Hematology/Oncology, Dong-A University Hospital, Busan, Korea
| | - Ik Chan Song
- Department of Hematology/Oncology, Chungnam National University Hospital, Daejeon, Korea
| | - Ji Hyun Kwon
- Department of Hematology/Oncology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yoo Jin Lee
- Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea
- Correspondence to Yoo Jin Lee, M.D. Department of Hematology/Oncology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-420-5587 Fax: +82-53-426-2046 E-mail:
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Murakami K, Ueno H, Okabe T, Kagoo T, Boku S, Yano T, Yokoyama A. Bridging-to-transplant with Azacitidine for Myelodysplastic Syndrome and Acute Myeloid Leukemia, Reduces the Incidence of Acute Graft- versus-host Disease. Hematol Rep 2017; 9:7114. [PMID: 28670436 PMCID: PMC5477469 DOI: 10.4081/hr.2017.7114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/24/2017] [Accepted: 05/09/2017] [Indexed: 11/23/2022] Open
Abstract
Allogeneic stem cell transplantation (allo-SCT) is the only curative option for myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Azacitidine (AZA) has a good toxicity profile compared with intensive chemotherapy and can be considered a pre-transplant regimen in elderly patients and in patients with comorbidities. To investigate the impact of pre-transplant AZA on patient outcome after allo-SCT, we conducted a retrospective analysis of AZA pre-treatment followed by allo-SCT in patients with high-risk MDS and AML. Twenty patients who were divided into two groups according to AZA treatment given prior to allo-SCT (AZA vs non-AZA group, 10 each). Overall survival, event-free survival and incidence of chronic graft-versus-host disease (GVHD) were not significantly different between the two groups. The overall incidence of grade II to IV acute GVHD in the AZA group was significantly lower than that in the non-AZA group (P=0.004). Bridging to transplant with AZA should be considered as an immunomodulator and effective treatment strategy for patients with MDS and AML.
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Affiliation(s)
- Koichi Murakami
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hironori Ueno
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takashi Okabe
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Toshiya Kagoo
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Saigen Boku
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takahiro Yano
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Akihiro Yokoyama
- Division of Hematology, Department of Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Patriarca F, Giaccone L, Onida F, Castagna L, Sarina B, Montefusco V, Mussetti A, Mordini N, Maino E, Greco R, Peccatori J, Festuccia M, Zaja F, Volpetti S, Risitano A, Bassan R, Corradini P, Ciceri F, Fanin R, Baccarani M, Rambaldi A, Bonifazi F, Bruno B. New drugs and allogeneic hematopoietic stem cell transplantation for hematological malignancies: do they have a role in bridging, consolidating or conditioning transplantation treatment? Expert Opin Biol Ther 2017; 17:821-836. [PMID: 28506131 DOI: 10.1080/14712598.2017.1324567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Novel targeted therapies and monoclonal antibodies can be combined with allogeneic stem cell transplantation (allo-SCT) at different time-points: 1) before the transplant to reduce tumour burden, 2) as part of the conditioning in place of or in addition to conventional agents 3) after the transplant to allow long-term disease control. Areas covered: This review focuses on the current integration of new drugs with allo-SCT for the treatment of major hematological malignancies for which allo-SCT has been a widely-adopted therapy. Expert opinion: After having been used as single agent salvage treatments in relapsed patients after allo-SCT or in combination with donor lymphocyte infusions, many new drugs have also been safely employed before allo-SCT as a bridge to transplantation or after it as planned consolidation/maintenance. This era of new drugs has opened new important opportunities to 'smartly' combine 'targeted drugs and cell therapies' in new treatment paradigms that may lead to higher cure rates or longer disease control in patients with hematological malignancies.
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Affiliation(s)
- Francesca Patriarca
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Luisa Giaccone
- b A.O.U. Città della Salute e della Scienza di Torino, Department of Oncology and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Francesco Onida
- c Hematology, Maggiore Hospital , University of Milano, Milan , Italy
| | | | | | - Vittorio Montefusco
- e Hematology and Bone Marrow Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Alberto Mussetti
- e Hematology and Bone Marrow Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Nicola Mordini
- f Hematology , S. Croce e Carle Hospital , Cuneo , Italy
| | - Elena Maino
- g Hematology , Hospital of Mestre (Ve) , Mestre (Ve) , Italy
| | - Raffaella Greco
- h Hematology and Bone Marrow Transplantation Unit , IRCCS San Raffaele Scientific Institute , Milano , Italy
| | - Jacopo Peccatori
- h Hematology and Bone Marrow Transplantation Unit , IRCCS San Raffaele Scientific Institute , Milano , Italy
| | - Moreno Festuccia
- b A.O.U. Città della Salute e della Scienza di Torino, Department of Oncology and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
| | - Francesco Zaja
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Stefano Volpetti
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Antonio Risitano
- i Division of Hematology , Federico II University of Naples , Naples , Italy
| | - Renato Bassan
- g Hematology , Hospital of Mestre (Ve) , Mestre (Ve) , Italy
| | - Paolo Corradini
- e Hematology and Bone Marrow Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Renato Fanin
- a Hematology, DAME , University Hospital, University of Udine , Udine , Italy
| | - Michele Baccarani
- k Hematology , University-Hospital S. Orsola-Malpighi, University of Bologna , Bologna , Italy
| | - Alessandro Rambaldi
- l Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo , University of Milan , Milan , Italy
| | - Francesca Bonifazi
- k Hematology , University-Hospital S. Orsola-Malpighi, University of Bologna , Bologna , Italy
| | - Benedetto Bruno
- b A.O.U. Città della Salute e della Scienza di Torino, Department of Oncology and Department of Molecular Biotechnology and Health Sciences , University of Torino , Torino , Italy
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Zhang SD, Feng SZ. [Advances in allogeneic hematopoietic stem cell transplantation for myelodysplastic syndromes]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:432-6. [PMID: 27210885 PMCID: PMC7348315 DOI: 10.3760/cma.j.issn.0253-2727.2016.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Indexed: 11/24/2022]
Affiliation(s)
- S D Zhang
- Institute of Hematology & Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
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