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<p>Reduced intensity conditioning (RIC) is usually used for patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (allo-HCT), particularly in the elderly or those with comorbidities. The impact of conditioning intensity on patients’ outcome remains controversial with clinicians’ subjective opinion/ experience remaining a major guide in choosing the intensity. Here, we compare RIC <i>versus</i> MAC in a large EBMT retrospective study in MDS patients aged ≥50 years undergoing allo-HCT between 2014 and 2018. Among the 1393 included patients, 922 (66%) were males, and the median age at transplant was 62.8 (50.0–77.9) years. The majority of patients (<i>n</i> = 884; 64.3%) had MDS with excess blasts. IPSS-R recorded was very low/low (<i>n</i> = 598, 43%), intermediate (<i>n</i> = 352, 25%), and high/very high (<i>n</i> = 443, 32%). Karnofsky index was ≥90 in 916 (69.3%) patients, and HCT-CI ≥ 3 in 292(27.3%) patients. A RIC regimen was used in 1053 (75.5%) patients. Median follow-up was 27.9 months (IQR: 26.4–30.6). Both uni- and multi-variable analyses did not show any significant association between conditioning intensity and outcomes. This study highlights a lack of association between RIC/MAC regimens and outcomes in allo-HCT MDS patients. Our results support the recently published systematic review and meta-analysis, where evidence for using one conditioning regimen over another remains weak.</p>

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Conditioning intensity in myelodysplastic patients aged ≥ 50 years undergoing allogeneic hematopoietic cell transplantation (allo-HCT): a study on behalf of the chronic malignancies working party of the EBMT

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  • 发表日期：

    2025年8月29日

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  • Noureddine Henoun Loukili,
  • Luuk Gras,
  • Linda Koster,
  • Didier Blaise,
  • Tobias Gedde-Dahl,
  • Johan Maertens,
  • Lone Smidstrup Friis,
  • Stephan Mielke,
  • Patrice Chevallier,
  • Jakob R. Passweg,
  • Jennifer Louise Byrne,
  • Urpu Salmenniemi,
  • Patrice Ceballos,
  • Jérôme Cornillon,
  • Simona Sica,
  • Francesco Onida,
  • Christof Scheid,
  • Carmelo Gurnari,
  • Joanna Drozd-Sokolowska,
  • Kavita Raj,
  • Marie Robin,
  • Donal P. McLornan,
  • Ibrahim Yakoub-Agha

摘要

Reduced intensity conditioning (RIC) is usually used for patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (allo-HCT), particularly in the elderly or those with comorbidities. The impact of conditioning intensity on patients’ outcome remains controversial with clinicians’ subjective opinion/ experience remaining a major guide in choosing the intensity. Here, we compare RIC versus MAC in a large EBMT retrospective study in MDS patients aged ≥50 years undergoing allo-HCT between 2014 and 2018. Among the 1393 included patients, 922 (66%) were males, and the median age at transplant was 62.8 (50.0–77.9) years. The majority of patients (n = 884; 64.3%) had MDS with excess blasts. IPSS-R recorded was very low/low (n = 598, 43%), intermediate (n = 352, 25%), and high/very high (n = 443, 32%). Karnofsky index was ≥90 in 916 (69.3%) patients, and HCT-CI ≥ 3 in 292(27.3%) patients. A RIC regimen was used in 1053 (75.5%) patients. Median follow-up was 27.9 months (IQR: 26.4–30.6). Both uni- and multi-variable analyses did not show any significant association between conditioning intensity and outcomes. This study highlights a lack of association between RIC/MAC regimens and outcomes in allo-HCT MDS patients. Our results support the recently published systematic review and meta-analysis, where evidence for using one conditioning regimen over another remains weak.