ArticleBone marrow transplantation2025
Sequential versus standard conditioning in untreated MDS patients with blasts undergoing allogeneic HSCT.
Article in Bone marrow transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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25 authors.
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Abstract
Myelodysplastic syndromes (MDS) can progress to AML and often require allogeneic hematopoietic stem cell transplantation (allo-SCT). The sequential FLAMSA-FB regimen, featuring a cytoreductive FLAMSA phase followed by fludarabine-busulfan (FB) conditioning, may enhance disease control. We retrospectively analyzed 106 untreated MDS patients with blasts 5-19% at the University Medical Center Hamburg who received either FLAMSA-FB (n = 45) or standard conditioning (n = 61: Thiotepa-Busulfan (n = 30), Fludarabine-Busulfan (n = 16), Treosulfan-Fludarabine (n = 15)). Median follow-up was 24 months. The FLAMSA group was younger (median age 56 vs. 62, p = 0.02), but baseline IPSS risk scores (p = 0.16) and donor types (p = 0.43) were comparable. Engraftment rates were similar. At two years, overall survival (OS) was 62% with FLAMSA and 68% with standard conditioning (p = 0.92), while progression-free survival (PFS) was 56% vs. 59% (p = 0.92). Non-relapse mortality (22% vs. 25%, p = 0.78) and cumulative incidence of relapse (22% vs. 13%, p = 0.12) did not differ significantly, nor did grade II-IV acute graft-versus-host disease (GVHD). Propensity score matching in 18 pairs confirmed no significant differences in OS, PFS, NRM, or CIR. However, moderate-to-severe chronic GVHD was higher with FLAMSA-FB (50% vs. 17%, p = 0.04). Thus, FLAMSA-FB did not improve transplant outcomes over standard conditioning but was linked to an increased risk of chronic GVHD.
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