作者
Claire Michel,Marie Robin,Stéphane Morisset,Didier Blaise,Johan Maertens,Patrice Chevalier,Cristina Castilla‐Llorente,Édouard Forcade,Patrice Céballos,Ibrahim Yakoub‐Agha,Xavier Poiré,Martin Carré,Jacques‐Olivier Bay,Yves Béguin,Michaël Loschi,Anne Huynh,Gaëlle Guillerm,Sylvie François,Jean-Baptiste Méar,Rémy Duléry,Felipe Suárez,Karin Bilger,Jérôme Cornillon,Yves Chalandon,Natacha Maillard,Hélène Labussière‐Wallet,A Charbonnier,Pascal Turlure,Ana Berceanu,Sylvain Chantepie,Sébastien Maury,Ali Bazarbachi,Anne‐Lise Ménard,Stéphanie Nguyen‐Quoc,Marie‐Thérèse Rubio,Maud D’Aveni-Piney
摘要
Allogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2-4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32-1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28-1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome.