Gregory A Abel1, John Koreth. 1. Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
Abstract
PURPOSE OF REVIEW: This review examines reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT) for older patients (age ≥60 years) with myelodysplastic syndromes (MDS), focusing on how to choose candidates for HSCT as well as data on the comparative effectiveness of RIC HSCT versus other treatment approaches. RECENT FINDINGS: For some older patients with MDS, there may be a survival advantage for RIC HSCT compared with nontransplantation approaches. Health service approaches suggest that optimal treatment choice varies with MDS risk. For those with low/intermediate-1 International Prognostic Scoring System (IPSS) risk, non-HSCT treatments may be preferred, but for intermediate-2/high IPSS patients, RIC HSCT may be better, even after adjusting for quality of life (QoL). SUMMARY: The optimal positioning of HSCT for older patients with MDS is evolving. Available data suggest that for older patients with higher risk MDS, if their QoL is affected and they are medically fit, RIC HSCT may lead to more favourable outcomes. Prospective trials in older patients with MDS are necessary to confirm the putative benefit of RIC HSCT.
PURPOSE OF REVIEW: This review examines reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT) for older patients (age ≥60 years) with myelodysplastic syndromes (MDS), focusing on how to choose candidates for HSCT as well as data on the comparative effectiveness of RIC HSCT versus other treatment approaches. RECENT FINDINGS: For some older patients with MDS, there may be a survival advantage for RIC HSCT compared with nontransplantation approaches. Health service approaches suggest that optimal treatment choice varies with MDS risk. For those with low/intermediate-1 International Prognostic Scoring System (IPSS) risk, non-HSCT treatments may be preferred, but for intermediate-2/high IPSS patients, RIC HSCT may be better, even after adjusting for quality of life (QoL). SUMMARY: The optimal positioning of HSCT for older patients with MDS is evolving. Available data suggest that for older patients with higher risk MDS, if their QoL is affected and they are medically fit, RIC HSCT may lead to more favourable outcomes. Prospective trials in older patients with MDS are necessary to confirm the putative benefit of RIC HSCT.
Authors: K Rebecca Fega; Gregory A Abel; Gabriela Motyckova; Alexander E Sherman; Daniel J DeAngelo; David P Steensma; Ilene Galinsky; Martha Wadleigh; Richard M Stone; Jane A Driver Journal: J Geriatr Oncol Date: 2015-06-11 Impact factor: 3.599
Authors: A El-Jawahri; H T Kim; D P Steensma; A M Cronin; R M Stone; C D Watts; Y-B Chen; C S Cutler; R J Soiffer; G A Abel Journal: Bone Marrow Transplant Date: 2016-03-21 Impact factor: 5.483
Authors: Gregory A Abel; Fabio Efficace; Rena J Buckstein; Sara Tinsley; Joseph G Jurcic; Yolanda Martins; David P Steensma; Corey D Watts; Azra Raza; Stephanie J Lee; Alan F List; Robert J Klaassen Journal: Haematologica Date: 2016-03-04 Impact factor: 9.941
Authors: Ellen R M Scheepers; Ariel M Vondeling; Noortje Thielen; René van der Griend; Reinhard Stauder; Marije E Hamaker Journal: Haematologica Date: 2020-05-07 Impact factor: 9.941
Authors: Aleksandar Radujkovic; Natalia Becker; Axel Benner; Olaf Penack; Uwe Platzbecker; Friedrich Stölzel; Martin Bornhäuser; Ute Hegenbart; Anthony D Ho; Peter Dreger; Thomas Luft Journal: Oncotarget Date: 2015-10-27
Authors: Gregory A Abel; Haesook T Kim; Andrew Hantel; David P Steensma; Richard Stone; Anand Habib; Vincent T Ho; Martha Wadleigh; Areej El-Jawahri; Edwin P Alyea; Daniel J DeAngelo; John Koreth; Joseph H Antin; Robert J Soiffer; Corey Cutler Journal: Leukemia Date: 2020-11-17 Impact factor: 11.528