Conditioning intensity in myelodysplastic patients aged ≥ 50 years undergoing allogeneic hematopoietic cell transplantation (allo-HCT): a study on behalf of the chronic malignancies working party of the EBMT

Reduced intensity conditioning (RIC) is usually used for patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (allo-HCT), particularly in the elderly or those with comorbidities. The impact of conditioning intensity on patients' outcome remains controversial with clinicians' subjective opinion/ experience remaining a major guide in choosing the intensity. Here, we compare RIC versus MAC in a large EBMT retrospective study in MDS patients aged ≥50 years undergoing allo-HCT between 2014 and 2018. Among the 1393 included patients, 922 (66%) were males, and the median age at transplant was 62.8 (50.0-77.9) years. The majority of patients (n = 884; 64.3%) had MDS with excess blasts. IPSS-R recorded was very low/low (n = 598, 43%), intermediate (n = 352, 25%), and high/very high (n = 443, 32%). Karnofsky index was ≥90 in 916 (69.3%) patients, and HCT-CI ≥ 3 in 292(27.3%) patients. A RIC regimen was used in 1053 (75.5%) patients. Median follow-up was 27.9 months (IQR: 26.4-30.6). Both uni- and multi-variable analyses did not show any significant association between conditioning intensity and outcomes. This study highlights a lack of association between RIC/MAC regimens and outcomes in allo-HCT MDS patients. Our results support the recently published systematic review and meta-analysis, where evidence for using one conditioning regimen over another remains weak.

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Journal
Bone Marrow Transplantation
Published
2025-08-29
DOI
https://doi.org/10.1038/s41409-025-02682-3
Citations
1
Primary Topic
Acute Myeloid Leukemia Research
Type
article
Field-Weighted Citation Impact
1.77
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article

Conditioning intensity in myelodysplastic patients aged ≥ 50 years undergoing allogeneic hematopoietic cell transplantation (allo-HCT): a study on behalf of the chronic malignancies working party of the EBMT

Kavita K Raj, Jakob Robert Passweg, Marie Robin, Urpu Salmenniemi et al.
1 citations
Bone Marrow Transplantation
Acute Myeloid Leukemia Research
1.77
article

Conditioning intensity in myelodysplastic patients aged ≥ 50 years undergoing allogeneic hematopoietic cell transplantation (allo-HCT): a study on behalf of the chronic malignancies working party of the EBMT

Kavita K Raj, Jakob Robert Passweg, Marie Robin, Urpu Salmenniemi, Donal P. McLornan, Christof Scheid, Didier Blaise, Patrice Chevallier, Luuk Gras, Stephan Mielke, Jérôme Cornillon, Ibrahim Yakoub‐Agha, Patrice Céballos, Carmelo Gurnari, Francesco Onida, Tobias Gedde‐Dahl, Joanna Ewa Drozd-Sokolowska, Simona Sica, Jenny Byrne, Johan A. Maertens, Lone Smidstrup Friis, Linda Köster, Noureddine Loukili
article en
1 citations

Abstract

Reduced intensity conditioning (RIC) is usually used for patients with myelodysplastic syndrome (MDS) undergoing allogeneic hematopoietic cell transplantation (allo-HCT), particularly in the elderly or those with comorbidities. The impact of conditioning intensity on patients' outcome remains controversial with clinicians' subjective opinion/ experience remaining a major guide in choosing the intensity. Here, we compare RIC versus MAC in a large EBMT retrospective study in MDS patients aged ≥50 years undergoing allo-HCT between 2014 and 2018. Among the 1393 included patients, 922 (66%) were males, and the median age at transplant was 62.8 (50.0-77.9) years. The majority of patients (n = 884; 64.3%) had MDS with excess blasts. IPSS-R recorded was very low/low (n = 598, 43%), intermediate (n = 352, 25%), and high/very high (n = 443, 32%). Karnofsky index was ≥90 in 916 (69.3%) patients, and HCT-CI ≥ 3 in 292(27.3%) patients. A RIC regimen was used in 1053 (75.5%) patients. Median follow-up was 27.9 months (IQR: 26.4-30.6). Both uni- and multi-variable analyses did not show any significant association between conditioning intensity and outcomes. This study highlights a lack of association between RIC/MAC regimens and outcomes in allo-HCT MDS patients. Our results support the recently published systematic review and meta-analysis, where evidence for using one conditioning regimen over another remains weak.

Bone Marrow TransplantationVol. 60(11)
Università Cattolica del Sacro Cuore (IT), University of Rome Tor Vergata (IT), Oslo University Hospital (NO), Cleveland Clinic (US), Karolinska University Hospital (SE), University College London Hospitals NHS Foundation Trust (GB), University of Nottingham (GB), Inserm (FR), University of Cologne (DE), Université Paris Cité (FR), Université de Lille (FR), Medical University of Warsaw (PL), Universitair Ziekenhuis Leuven (BE), Helsinki University Hospital (FI), Turku University Hospital (FI), University Hospital of Basel (CH), Copenhagen University Hospital (DK), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire de Nantes (FR), Centre Hospitalier Universitaire de Montpellier (FR), Assistance Publique – Hôpitaux de Paris (FR), European Society for Blood and Marrow Transplantation (NL), Laboratoire de Thermique et Energie de Nantes (FR), Institute Cancer De La Loire Lucien Neuwirth (FR), Centre d'Investigation Clinique de Nantes (FR), Central Clinical Hospital (PL), Hôpital Saint-Louis (FR), Institut Paoli-Calmettes (FR), Centre Hospitalier Universitaire de Saint-Étienne (FR), University College London (GB), Nantes Université (FR)
Openalex Percentile: Top 13%
Acute Myeloid Leukemia Research
1.77
DOIOpen Access PDFOpenAlex
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