Choice of a different donor reduces relapse risk after second allogeneic SCT for MDS

Myelodysplastic neoplasms (MDS) relapsing after allogeneic stem cell transplantation (alloSCT) have a poor prognosis. A second alloSCT (alloSCT2) can offer durable remission, however, earlier studies reported <20% long-term survival. Here we summarize contemporary outcome and risk factors after alloSCT2 (2012-2023), particularly focusing on donor change (DoC). We included 313 adults undergoing alloSCT2 for MDS relapse. Donors for alloSCT2 were matched- related/unrelated/haploidentical in 19%/62%/19%, with DoC reported in 71%. Two-year overall-/progression-free survival (OS/PFS), cumulative relapse incidence (RI) and non-relapse mortality (NRM) from alloSCT2 were 45%/33%/37%/30%. Outcome improved over time (2y-OS/PFS: 51%/39% in years 2018-2023). In multivariable analyses, DoC was associated with lower risk of relapse (HR=0.56, 95%-CI: 0.36-0.89), a finding never observed after alloSCT2 for acute leukemia. Additionally, adverse cytogenetics were correlated with relapse risk (HR=1.93, 95%-CI: 1.18-3.17). Risk of NRM decreased in more recent years (HR=0.88, per year later) and in patients with Karnofsky performance score (KPS) ≥90 at alloSCT2 (HR=0.59). Concerning survival, remission after alloSCT1 ≥12 months (HR=0.62/0.67) and KPS ≥90 (HR=0.68/0.69) were associated with better OS/PFS. In summary, we report improved outcomes of alloSCT2 in MDS in more recent years and demonstrate superior disease control by DoC, although a trend toward increased NRM precluded a significant survival benefit.

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Journal
Blood
Published
2026-10-07
DOI
https://doi.org/10.1182/blood.2026033876
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
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article

Choice of a different donor reduces relapse risk after second allogeneic SCT for MDS

Kavita K Raj, Nicolaus Martin Kröger, Jakob Robert Passweg, Marie Robin et al.
Blood
Hematopoietic Stem Cell Transplantation
article

Choice of a different donor reduces relapse risk after second allogeneic SCT for MDS

Kavita K Raj, Nicolaus Martin Kröger, Jakob Robert Passweg, Marie Robin, Donal P. McLornan, Alexandros Spyridonidis, Wolfgang Andreas Bethge, Linde M. Morsink, Giuliano Filippini Velázquez, Jan Vydra, Carmelo Gurnari, Francesco Onida, Jan Frederic Weller, Joanna Ewa Drozd-Sokolowska, Katja Sockel, Uwe Platzbecker, Johan A. Maertens, Elisa Sala, Schmid Christoph, Linda Köster, Thomas Schroeder, Christof Scheid, Luuk Gras, Victoria Potter, Laurien Greetje Antoinette Baaij
article en

Abstract

Myelodysplastic neoplasms (MDS) relapsing after allogeneic stem cell transplantation (alloSCT) have a poor prognosis. A second alloSCT (alloSCT2) can offer durable remission, however, earlier studies reported <20% long-term survival. Here we summarize contemporary outcome and risk factors after alloSCT2 (2012-2023), particularly focusing on donor change (DoC). We included 313 adults undergoing alloSCT2 for MDS relapse. Donors for alloSCT2 were matched- related/unrelated/haploidentical in 19%/62%/19%, with DoC reported in 71%. Two-year overall-/progression-free survival (OS/PFS), cumulative relapse incidence (RI) and non-relapse mortality (NRM) from alloSCT2 were 45%/33%/37%/30%. Outcome improved over time (2y-OS/PFS: 51%/39% in years 2018-2023). In multivariable analyses, DoC was associated with lower risk of relapse (HR=0.56, 95%-CI: 0.36-0.89), a finding never observed after alloSCT2 for acute leukemia. Additionally, adverse cytogenetics were correlated with relapse risk (HR=1.93, 95%-CI: 1.18-3.17). Risk of NRM decreased in more recent years (HR=0.88, per year later) and in patients with Karnofsky performance score (KPS) ≥90 at alloSCT2 (HR=0.59). Concerning survival, remission after alloSCT1 ≥12 months (HR=0.62/0.67) and KPS ≥90 (HR=0.68/0.69) were associated with better OS/PFS. In summary, we report improved outcomes of alloSCT2 in MDS in more recent years and demonstrate superior disease control by DoC, although a trend toward increased NRM precluded a significant survival benefit.

Blood
University College Hospital (GB), Cleveland Clinic (US), University Medical Center Groningen (NL), University College London Hospitals NHS Foundation Trust (GB), Universität Hamburg (DE), University of Patras (GR), University of Cologne (DE), University of Milan (IT), Medical University of Warsaw (PL), Universitair Ziekenhuis Leuven (BE), University Hospital Augsburg (DE), University Hospital of Basel (CH), Institute of Haematology and Blood Transfusion (CZ), European Society for Blood and Marrow Transplantation (NL), University Medical Center Hamburg-Eppendorf (DE), Essen University Hospital (DE), University Hospital Leipzig (DE), Hôpital Saint-Louis (FR), King's College Hospital (GB), University Hospital Ulm (DE), ASST Fatebenefratelli Sacco (IT), University Hospital Carl Gustav Carus (DE), University College London (GB), Technische Universität Dresden (DE), University of Tübingen (DE), KU Leuven (BE)
Openalex Percentile: Top 12%
Hematopoietic Stem Cell Transplantation
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