Home  Kurzfassungen Sitzung IV 4. N. Kröger, Transplantation - haben auch die Alten eine Chance? Abstract

Therapie bei Hochrisiko-MDS

Transplantation - haben auch die Alten eine Chance?

Prof. Dr. Nicolaus Kröger, Dept of Stem Cell Transplantation University Hospital Hamburg/Germany for MDS subcommittee of the Chronic Leukemia Working Party of the EBMT.

The treatment strategy with the highest curative potential for MDS patients is allogeneic stem cell transplantation. After standard myeloablative conditioning followed by HLA-identical sibling transplantation, disease-free survival rates between 29 and 40% were reported. The non-relapse mortality ranged between 37 and 50% and the relapse rate between 23 and 48%.

Therefore, despite the curative potential of allogeneic stem cell transplantation, more than 50% of the patients will fail to benefit from this treatment approach either due to treatment related mortality or to relapse after transplantation. The role of allogeneic stem cell transplantation in elderly patients is not clear. Until more recently this treatment approach has been performed only in younger patients due to its high treatment related morbidity and mortality. The introduction of dose-reduced or toxicity-reduced conditioning regimens before allografting has allowed to perform this procedure also in elderly patients, with MDS and several busulfan- or treosulfan-based regimens have been investigated to test feasibility and efficacy mainly in elderly patients. While using these regimens the therapy related mortality has been reduced significantly, but the relapse rate of about 30% remains a major issue.

The availability of MDS active drugs such as hypomethylating agents, histone-deacetylase inhibitors, lenalidomide and others, offers a new less toxic option to lower the number of blasts or induce cytogenetic remission prior to allogeneic stem cell transplantation, which might reduce the risk of relapse. Another option is the use of AML like induction chemotherapy followed immediately by a dose reduced conditioning and allografting in MDS patients with high number of blasts. These new exciting treatment possibilities have to be investigated or confirmed in well-designed clinical studies to demonstrate a clinical benefit for elderly MDS patients.