Increased opportunity for prolonged survival after allogeneic hematopoietic stem cell transplantation in patients aged 60-69years with myelodysplastic syndrome

We conducted a nationwide retrospective study to evaluate the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 651 patients aged 60-69years with de novo myelodysplastic syndrome (MDS). We divided patients into two groups: 152 and 499 patients with an early and advanced disease status, respectively. The 3-year overall survival (OS) rate of patients with an early disease status was 45.9% (95% confidence interval [CI], 37.0 to 54.2%). A multivariate analysis revealed five adverse factors for OS: performance status (PS) 2-4 (hazard ratio [HR] 4.48; P<.001), poor cytogenetic risk group (HR 1.83; P=.041), male recipient (HR 2.58; P=.003), use of HLA-mismatched related grafts (HR 4.75; P=.003), and unrelated cord blood (HR 2.47; P=.023). The 3-year OS rate of patients with an advanced disease status was 37.2% (95% CI 32.4 to 41.9%). Five factors correlated with worse OS: PS 2-4 (HR 1.72; P=.003), poor cytogenetic risk group (HR 1.49; P=.003), use of HLA-mismatched related grafts (HR 1.96; P=.015), unrelated cord blood (HR 2.05; P<.001), and the high number of red blood cell transfusions before transplantation (HR 1.85; P=.018). The present results revealed the more frequent utilization of allo-HSCT for MDS patients aged 60-69years, which increases the curative potential.