Blood Res.  2016 Mar;51(1):44-49. 10.5045/br.2016.51.1.44.

Survey of experts on therapeutic policies and proposals for the optimal timing for allogeneic peripheral blood stem cell transplantation in transfusion-dependent patients with myelodysplastic syndrome-refractory anemia

• Sohn SK
• Moon JH
• Lee YJ
• Park SW
• Kim JY

• KMID: 2172744
• DOI: http://doi.org/10.5045/br.2016.51.1.44

Abstract

BACKGROUND
Most hypomethylating agent (HMA) responders with myelodysplastic syndrome (MDS) eventually need allogeneic stem cell transplantation (SCT) because they often acquire resistance to HMAs within two years of treatment. Considering the nature of MDS and the poor outcomes of SCT when performed after confirming the progression of MDS to acute myeloid leukemia (AML), allogeneic SCT should be performed with caution in patients with low-risk MDS.
METHODS
To address low-risk MDS, the Korean AML/MDS working party group designed a survey for 34 MDS experts in Korea on therapeutic HMA and allogeneic SCT policies for low-risk MDS. The level of consensus was defined as the percentage of agreement among the experts.
RESULTS
With regard to the optimal time for allogeneic SCT for HMA responders with MDS-RA, 76% experts agreed that allogeneic SCT should be performed when a patient has a low platelet count. With regard to the relapse pattern that was most commonly found during HMA treatment in responding patients with MDS-RA, 54% experts agreed that the most common pattern that indicated HMA failure was the gradual worsening of cytopenia.
CONCLUSION
The optimal time to perform allogeneic SCT in RA patients who achieved hematologic complete remission during HMA treatment is when the platelet count decreases. However, these suggestions need to be evaluated in larger future studies. Therefore, careful decisions should be taken at each step of allogeneic SCT to maximize the outcomes for patients with MDS-RA and iron overload.

Keyword

Myelodysplastic; Transfusion; Hypomethylating; Allogeneic

MeSH Terms

Anemia*
Consensus
Humans
Iron Overload
Korea
Leukemia, Myeloid, Acute
Myelodysplastic Syndromes
Peripheral Blood Stem Cell Transplantation*
Platelet Count
Recurrence
Stem Cell Transplantation

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