21 December 2020

A stem cell transplant can be beneficial for older patients with myelodysplastic syndrome (MDS), according to results from a new study.

Transplant is widely used for younger patients, as it offers the only chance of a cure, but its benefits have not been proven in older patients. Now, researchers leading a US trial believe their results are likely to change practice.

Deciding if the likelihood of long-term benefit outweighs the risks associated with a transplant “is a critical clinical question for older adults with myelodysplastic syndrome, who often have comorbidities and are frail”, explained senior study author, Dr Corey Cutler of the Dana-Farber Cancer Institute, Boston, USA.

The trial compared the risks and benefits of donated haematopoietic stem cell transplant in 384 patients aged 50 to 75 years with intermediate or high-risk MDS, seen at 34 medical centres across the USA. Of these, 260 patients were matched to a donor within 90 days and received a transplant, while 124 patients received standard supportive care.

After three years, survival in the 260 patients who received the transplant was almost double that of the 124 who did not - 48% survival versus 27%.

Leukaemia-free survival at three years was also higher in the group who received the transplant at 36% compared with 21%. Both groups reported a similar quality of life.

The findings were presented on 5th December at the virtual American Society of Hematology annual meeting.

Dr Cutler says: “Transplantation has been underutilised, historically, in this patient group. Based on our findings all patients should at least be referred to a transplant centre so that those who are eligible and have a suitable donor can undergo transplant and have better survival.

“It is important to refer these patients early so the transplant center can work on finding an optimal donor right from the get-go.”

Source: A Multi-Center Biologic Assignment Trial Comparing Reduced Intensity Allogeneic Hematopoietic Cell Transplantation to Hypomethylating Therapy or Best Supportive Care in Patients Aged 50-75 with Advanced Myelodysplastic Syndrome: Blood and Marrow Transplant Clinical Trials Network Study 1102.  ASH 2020

 Link: https://ash.confex.com/ash/2020/webprogram/Paper136828.html

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