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Allogeneic and autologous stem cell transplantation in myelodysplastic syndromes
1Department of Haematology, University Hospital St. Radboud, Nijmegen, The Netherlands.
Insights
Allogeneic bone marrow transplantation offers a cure for myelodysplastic syndromes (MDSs) but is limited to a small patient group. Autologous transplants are an alternative, though higher recurrence rates in MDSs are noted, prompting further research.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Myelodysplastic syndromes (MDSs) are a group of clonal hematopoietic stem cell disorders.
- Allogeneic bone marrow transplantation (BMT) is the only curative option for MDSs.
- Allogeneic BMT is feasible in only a minority of patients due to age and donor availability.
Purpose of the Study:
- To discuss the role of autologous bone marrow transplantation (BMT) and autologous peripheral stem cell transplantation (APSCT) in managing myelodysplastic syndromes (MDSs).
- To evaluate the current indications and outcomes of autologous stem cell transplantation in MDSs.
- To highlight ongoing research comparing autologous transplantation with maintenance chemotherapy.
Main Methods:
- Review of current clinical practices and literature regarding autologous stem cell transplantation for MDSs.
- Discussion of chemotherapy regimens preceding autologous BMT in specific MDS subtypes.
- Mention of ongoing randomized studies comparing autologous transplantation with maintenance chemotherapy.
Main Results:
- Autologous BMT is considered for MDS patients achieving complete remission after aggressive chemotherapy.
- Autologous peripheral stem cell transplantation is a more recent alternative technique.
- Higher recurrence rates are observed with autologous transplantation in MDSs compared to de novo acute myeloblastic leukemia.
Conclusions:
- Autologous stem cell transplantation is a viable option for select MDS patients, particularly those ineligible for allogeneic BMT.
- Chemotherapy prior to autologous BMT warrants consideration in MDS with excess blasts.
- Further research, including randomized trials, is crucial to optimize treatment strategies and compare autologous transplantation with maintenance chemotherapy for MDSs.
Abstract:
Allogeneic bone marrow transplantation is the only currently available curative treatment for myelodysplastic syndromes (MDSs) but can be used only in the minority of patients (10%) who are younger than 55 years or so and for whom an HLA-identical donor is available. Each year in Europe, about 100 patients with MDSs receive an autologous bone marrow transplant. This procedure is usually indicated as first-line treatment, except in patients without excess of blasts or complex cytogenetic abnormalities. In forms with excess of blasts, chemotherapy prior to bone marrow transplantation deserves discussion. Autologous bone marrow transplants or the more recent technique involving transplantation of autologous peripheral stem cells can be considered in patients who have achieved a complete remission under aggressive chemotherapy. This method has been followed by higher recurrence rates in patients with MDSs than in those with de novo acute myeloblastic leukemia, and randomized studies are under way to compare it with aggressive maintenance chemotherapy.