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Older people with higher-risk myelodysplastic syndrome who had a matched donor and went on to a reduced-intensity stem-cell transplant were much more likely to be alive three years later than those without a donor treated with drugs, which makes transplant part of standard planning for fit patients up to 75.
Multicentre biologic assignment trial of the Blood and Marrow Transplant Clinical Trials Network: 384 patients aged 50 to 75 with intermediate-2 or high-risk de novo myelodysplastic syndrome enrolled at 34 centres between 2014 and 2018 were assigned to the donor arm (reduced-intensity allogeneic transplant) or the no-donor arm (hypomethylating therapy or best supportive care) according to whether a matched donor was identified within 90 days.
In the intention-to-treat analysis, adjusted three-year overall survival was 47.9 percent in the donor arm against 26.6 percent in the no-donor arm (absolute difference 21.3 percentage points), and leukaemia-free survival 35.8 against 20.6 percent. The benefit was seen across all subgroups examined.
Allogeneic transplant should be included in the management plan of fit older adults with higher-risk myelodysplastic syndrome; donor search should start at diagnosis.
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).
Shares Higher-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS).