Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel
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Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel. / de Witte, Theo; Bowen, David; Robin, Marie; Malcovati, Luca; Niederwieser, Dietger; Yakoub-Agha, Ibrahim; Mufti, Ghulam J; Fenaux, Pierre; Sanz, Guillermo; Martino, Rodrigo; Alessandrino, Emilio Paolo; Onida, Francesco; Symeonidis, Argiris; Passweg, Jakob; Kobbe, Guido; Ganser, Arnold; Platzbecker, Uwe; Finke, Jürgen; van Gelder, Michel; van de Loosdrecht, Arjan A; Ljungman, Per; Stauder, Reinhard; Volin, Liisa; Deeg, H Joachim; Cutler, Corey; Saber, Wael; Champlin, Richard; Giralt, Sergio; Anasetti, Claudio; Kröger, Nicolaus.
in: BLOOD, Jahrgang 129, Nr. 13, 30.03.2017, S. 1753-1762.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel
AU - de Witte, Theo
AU - Bowen, David
AU - Robin, Marie
AU - Malcovati, Luca
AU - Niederwieser, Dietger
AU - Yakoub-Agha, Ibrahim
AU - Mufti, Ghulam J
AU - Fenaux, Pierre
AU - Sanz, Guillermo
AU - Martino, Rodrigo
AU - Alessandrino, Emilio Paolo
AU - Onida, Francesco
AU - Symeonidis, Argiris
AU - Passweg, Jakob
AU - Kobbe, Guido
AU - Ganser, Arnold
AU - Platzbecker, Uwe
AU - Finke, Jürgen
AU - van Gelder, Michel
AU - van de Loosdrecht, Arjan A
AU - Ljungman, Per
AU - Stauder, Reinhard
AU - Volin, Liisa
AU - Deeg, H Joachim
AU - Cutler, Corey
AU - Saber, Wael
AU - Champlin, Richard
AU - Giralt, Sergio
AU - Anasetti, Claudio
AU - Kröger, Nicolaus
N1 - © 2017 by The American Society of Hematology.
PY - 2017/3/30
Y1 - 2017/3/30
N2 - An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.
AB - An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Leukemia, Myelomonocytic, Chronic
KW - Myelodysplastic Syndromes
KW - Practice Guidelines as Topic
KW - Risk Factors
KW - Transplantation Conditioning
KW - Transplantation, Homologous
KW - Journal Article
KW - Review
U2 - 10.1182/blood-2016-06-724500
DO - 10.1182/blood-2016-06-724500
M3 - SCORING: Review article
C2 - 28096091
VL - 129
SP - 1753
EP - 1762
JO - BLOOD
JF - BLOOD
SN - 0006-4971
IS - 13
ER -
