Outcomes of allogeneic hematopoietic cell transplantation (alloHCT) among selected older patients with advanced myelodysplastic syndrome (MDS) are similar to younger patients with MDS according to research presented at the 62nd ASH Annual Meeting and Exposition.
This multi-center biologic assignment trial conducted by the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) compared the outcomes of the use of HCT over non-HCT therapy in older patients with high-risk MDS. The study highlighted a significant overall survival (OS) with Int-2 and High IPSS risk de novo patients ages 50 to 75 who received reduced intensity conditioning (RIC) before HCT and had a suitable HLA-matched (8/8) donor.
The benefit of having a matched donor was seen across all subgroups, including those who were of Medicare age. Currently, alloHCT remains the only curative therapy for MDS but is infrequently offered to older patients and is only available to Medicare patients that enroll on a clinical trial.
Balanced for age, gender, KPS, IPSS risk, MDS disease duration, and response to hypomethylating therapy, 384 subjects (donor n=260, no donor n=124) at 34 centers were enrolled in the study between January 2014 and November 2018. Individuals joined prior to initiation of a formal donor search, and before or after MDS treatment was introduced. All patients were initially assigned to the no donor arm; however, if a suitable donor was identified within 90 days, they were reassigned to the donor arm.
The adjusted OS results at 3 years for the donor arm was 47.9% compared with 26.6% in the no donor arm with an absolute difference of 21.3%. The leukemia-free survival (LFS) at 3 years was 35.8% in the donor arm compared with 20.6% in the no donor arm. An OS and LFS benefit was seen across all subgroups tested. Thus researchers concluded that HCT should be offered to patients ages 50-75 with a suitable donor.