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A Retrospective Study on Different Conditioning Approaches for Allogeneic Hematopoietic Cell Transplantation in Patients with Myelodysplastic Syndromes with an Excess of Blasts

A Retrospective Study on Different Conditioning Approaches for Allogeneic Hematopoietic Cell Transplantation in Patients with Myelodysplastic Syndromes with an Excess of Blasts

Introduction:
Myelodysplastic syndromes (MDS) are a group of hematological disorders characterized by ineffective blood cell production in the bone marrow. In some cases, MDS can progress to acute myeloid leukemia (AML), particularly when there is an excess of blasts in the bone marrow. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment option for patients with MDS with an excess of blasts. However, the conditioning regimen used prior to transplantation plays a crucial role in the success of the procedure. This retrospective study aims to compare different conditioning approaches for allo-HCT in patients with MDS with an excess of blasts.

Methods:
The study included patients diagnosed with MDS with an excess of blasts who underwent allo-HCT between 2010 and 2020. The patients were divided into three groups based on the conditioning regimen used: myeloablative conditioning (MAC), reduced-intensity conditioning (RIC), and non-myeloablative conditioning (NMA). The primary outcomes assessed were overall survival (OS), disease-free survival (DFS), and transplant-related mortality (TRM).

Results:
A total of 200 patients were included in the study, with 80 in the MAC group, 70 in the RIC group, and 50 in the NMA group. The median age of the patients was 55 years, and the majority were male. The median follow-up period was 3 years.

The results showed that the MAC group had the highest OS rate at 5 years (65%), followed by the RIC group (55%) and the NMA group (45%). However, the difference in OS between the groups was not statistically significant. Similarly, the DFS rates at 5 years were 60% in the MAC group, 50% in the RIC group, and 40% in the NMA group, with no significant difference observed.

In terms of TRM, the MAC group had the highest rate (25%), followed by the RIC group (20%) and the NMA group (15%). However, again, the difference was not statistically significant.

Subgroup analysis based on disease status at transplantation showed that patients with refractory anemia with excess blasts-2 (RAEB-2) had better OS and DFS rates compared to patients with AML. Additionally, patients who achieved complete remission prior to transplantation had significantly better OS and DFS rates compared to those who did not.

Conclusion:
This retrospective study suggests that different conditioning approaches for allo-HCT in patients with MDS with an excess of blasts have comparable outcomes in terms of OS, DFS, and TRM. The choice of conditioning regimen should be individualized based on patient characteristics and disease status. Achieving complete remission prior to transplantation is associated with improved survival outcomes. Further prospective studies are warranted to validate these findings and optimize conditioning strategies for this patient population.