Allogeneic Stem Cell Transplantation for MDS

被引:2
作者
Villar, Sara [1 ]
Robin, Marie [2 ]
机构
[1] Clin Univ Navarra, Hematol Dept, Pamplona 31008, Spain
[2] Hop St Louis, AP HP, Hematol Greffe, F-75010 Paris, France
来源
HEMATO | 2021年 / 2卷 / 03期
关键词
myelodysplastic syndromes; stem cell transplantation; IPSS score; cytogenetic risk group; relapse; organ toxicity; co-morbid conditions; ACUTE MYELOID-LEUKEMIA; ACUTE MYELOGENOUS LEUKEMIA; RISK MYELODYSPLASTIC SYNDROME; BONE-MARROW-TRANSPLANTATION; MALIGNANCIES WORKING PARTY; PROGNOSTIC SCORING SYSTEM; MINIMAL RESIDUAL DISEASE; DRIVER SOMATIC MUTATIONS; RETROSPECTIVE ANALYSIS; EUROPEAN-SOCIETY;
D O I
10.3390/hemato2030034
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Myelodysplastic syndromes are clonal disorders with morphological dysplasia, a variable degree of cytopenia and a risk of transformation to acute myeloid leukemia. Prognosis is very variable and is defined by blast count, cytopenia, cytogenetics and more recently by somatic mutations, with IPSS or revised IPSS score being the most widely used to assess disease risk. HSCT remains the only curative treatment to date, with high-risk patients obtaining the biggest benefit. However, NRM should be carefully assessed before indicating the transplant in this usually old population, where organ toxicity and comorbid conditions are to be considered. Multi-domain assessment tools, such as CGA (comprehensive geriatric assessment) and EBMT score, are useful in this context and might guide physician decisions regarding the transplant. Indeed, with the development of reduced intensity conditioning regimens, the number of patient candidates for an HSCT has increased. Regarding pre-transplant treatment, patients with a blast excess > 10% might be treated with HMAs or chemotherapy, although there are no randomized trials confirming the benefit of this approach, even when achieving a complete response. Concerning donor choice, matched sibling donors continue to be the first option, although matched unrelated donors, and more recently haploidentical donors, have proven to be valid options and should be offered in the absence of a related donor. Relapse remains the main cause of transplantation failure. MRD assessment and pre-emptive or prophylactic use of HMA or other targeted inhibitors with or without DLI are accepted strategies to reduce relapse risk, but the prognosis in this context remains dismal, and is the subject for several ongoing clinical protocols.
引用
收藏
页码:545 / 555
页数:11
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