A1 Refereed original research article in a scientific journal
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
Authors: Henoun Loukili, Noureddine; Gras, Luuk; Koster, Linda; Blaise, Didier; Gedde-Dahl, Tobias; Maertens, Johan; Friis, Lone Smidstrup; Mielke, Stephan; Chevallier, Patrice; Passweg, Jakob R.; Byrne, Jennifer Louise; Salmenniemi, Urpu; Ceballos, Patrice; Cornillon, Jérôme; Sica, Simona; Onida, Francesco; Scheid, Christof; Gurnari, Carmelo; Drozd-Sokolowska, Joanna; Raj, Kavita; Robin, Marie; McLornan, Donal P.; Yakoub-Agha, Ibrahim
Publisher: SPRINGERNATURE
Publication year: 2025
Journal:: Bone Marrow Transplantation
ISSN: 0268-3369
eISSN: 1476-5365
DOI: https://doi.org/10.1038/s41409-025-02682-3
Web address : https://www.nature.com/articles/s41409-025-02682-3
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/500346747
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.
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Funding information in the publication:
The European Group for Blood and Bone Marrow Transplantation (EBMT) is a non-profit medical and scientific organization. The EBMT was responsible for the administrative and legal management of the study, as well as securing funding. No pharmaceutical companies or external funding sources were involved in any capacity, including study design, data collection, analysis, interpretation, or the preparation of the report. Additionally, no medical writers or editors contributed to the development of this manuscript. Open access funding provided by Centre Hospitalier Universitaire de Lille.
