Myelodysplastic Syndromes or Leukemia Following MDS Treated with Allogeneic Bone Marrow Transplantation: A Survey of the Working Party on Chronic Leukemia of the European Cooperative Group for Blood and Marrow Transplantation

Allogeneic bone marrow transplantation (BMT) offers potential cure for younger patients with myelodysplastic syndromes (MDS) or secondary acute myeloid leukemia (sAML). Until now 450 patients from more than 45 European centers have been reported to the European BMT group (EBMTG). We retrospectively analyzed those patients who received allogeneic BMT without prior remission induction chemotherapy (n = 107). Ninenty-one marrow donors were genotypically HLA-identical siblings and 16% received T cell-depleted marrow. The 4-year disease-free and overall survival for the entire group of patients was 31% and 39%, respectively. Forty-three patients (40%) died from transplantation-related complications, most often graft-versus-host disease and/or infections. MDS/AML recurred in 27 patients between 1 and 36 months after transplant, for an actuarial probability of relapse of 34% at 4 years. Disease-free and overall survival was dependent on the pretransplant bone marrow blast count. Patients with refractory anemia (RA)/RA with ring sideroblasts (RARS), RA with excess of blasts (RAEB), RAEB in transformation (RAEB/T), and sAML had a 4-year disease-free survival of 45%, 33%, 24%, and 20%, respectively. The 4-year overall survival for the respective patient groups was 52%, 46%, 23%, and 22%. Younger age was a favorable prognostic factor for overall survival and transplant-related mortality. In addition, a longer interval between MDS/sAML and BMT was associated with a higher incidence of transplant-related mortality. From these data, we conclude that allogeneic BMT without prior remission induction chemotherapy can be recommended for younger patients with early-stage MDS.