H e m a t o lo g y E d u c a t io n - European Hematology Association

London, United Kingdom, June 9-12, 2011
Figure 2. Kaplan-Meier curves of RFS, comparing NMA (---) vs SMC (___) patients among risk groups A(I), B(II), C(III), and
D(IV) taken from Sorror et al. J Clin Oncol 2007, 25, 4246-54; with permission.
patients with an excess of blasts showed an OS at 5
years of only 25–28% despite HSCT.
Prospective evaluation of the contribution of dynamic
changes, such as progression of cytopenia, acquisition of
cytogenetic abnormalities, and transfusion dependence to
outcomes for HSCT are required and will help to clarify
the optimal timing for transplantation with respect to
lower risk MDS. It is hoped that the identification of
newer prognostic markers, using cytogenetic, 32-34
immunophenotypic, 34 and molecular techniques, such as
high density single nucleotide polymorphism (SNP) analysis,
gene-expression profiling, 35 and other molecular markers,
such as EZH2, DNMT3A, and ASXL1 36 mutations will
enable further improvement in terms of risk stratification,
particularly for patients with low-risk disease. 37
Requirement for cytoreductive therapy prior
to hematopoietic stem cell transplantation
The persistent risk of relapse of MDS post HSCT
remains the major factor undermining the potential for
long-term cure provided by this treatment modality.
Whilst RIC HSCT has extended the applicability of
HSCT to older patients with MDS, this is offset by an
apparent greater risk of relapse seen with RIC regimens.
Prospective data is lacking, but several groups have
reported a higher relapse rate following RIC HSCT. 10,38,39
In a retrospective comparison of 836 MDS patients
undergoing RIC versus SMC matched sibling HSCT, the
3-year relapse rate was significantly increased in
patients undergoing RIC (cumulative incidence 45% vs.
27% for patients undergoing SMC) but the low NRM in
this group resulted in similar OS between RIC and SMC
patients. Advanced phase disease and patients not in CR
at transplantation also had a significantly increased risk
of relapse. Bearing in mind that increasing RIC HSCT
are likely to be performed for patients with MDS, it
would seem reasonable to consider ways to prevent
relapse, either by disease control prior to HSCT or by
the adoption of measures post transplant to prevent
relapse in those at greatest risk.
A recent EBMT study 10 described earlier (Tables 1 and
2), evaluating outcomes for 1,333 patients over 50 years
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