Usage of younger unmatched donors for allo-HCT improves some clinical outcomes in MDS patients

February 2022 Clinical trials Nalinee Pathak

Nurse comforting senior female patient

A recent study by Murthy et al. evaluated the clinical outcomes of patients with myelodysplastic syndrome receiving an allogeneic hematopoietic stem cell transplant (allo-HCT) from older matched sibling donors (MSDs) or young human leukocyte antigen–matched unrelated donors (MUDs). Results of this retrospective study were recently published in the journal JAMA Oncology.¹

The retrospective cohort study evaluated data of 1,761 adults (50+ years old) with myelodysplastic syndrome who underwent allo-HCT using either an older MSD (n=646) or younger MUD (n=1,115). The median follow up was for 48 months between Jan1, 2011 and Dec 31, 2017. The primary outcome of the study was disease-free survival (DFS), and secondary outcomes included overall survival (OS), relapse and nonrelapse mortality, acute graft-vs-host disease (GVHD), chronic GVHD, and GVHD-free relapse-free survival.

Results

The data analysis revealed that transplants from older MSDs resulted in a lower rate of DFS as compared to younger MUDs (HR [95% CI]: 1.17 [1.02-1.34]; p =0.02). However, no significant difference in OS rate was observed between these groups (HR [95% CI]: 1.13 [0.98-1.29]; p=0.07). Patients treated with allo-HCT from older MSDs showed significantly higher relapse mortality (HR[95% CI]: 1.62 [1.32-1.97]; p<0.001) and a lower rate of GVHD-free relapse-free survival beyond 12 months after allo-HCT compared to young MUDs (HR [95% CI]: 1.42 [1.02-1.98]; p=0.04). However, donations from older MSDs were also associated with lower nonrelapse mortality (HR [95% CI]: 0.76 [0.59-0.96]; p=0.02), lower acute GVHD (HR [95% CO]: 0.52 [0.42-0.65]; p<0.001) and less chronic GVHD (HR [95% CI]: 0.77 [0.64-0.92]; p=0.005),

Conclusion

In conclusion, allo-HCT from younger MUDs improved DFS outcomes and lowered the relapse-related mortality in patients with myelodysplastic syndrome. However, allo-HCT was inferior compared to MSDs in regards to nonrelapse mortality and different GVHD outcomes. Both forms of transplants seem to have their own advantages and disadvantages.

Reference