Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome

Allogeneic hematopoietic stem cell transplantation ( allo- SCT) is a curative treatment for myelodysplastic syndrome ( MDS). The object of this study was to evaluate the impact of chemotherapy before allo- SCT. We analyzed the data of 283 patients who underwent allo- SCT from an HLA- identical sibling donor for MDS that were reported to the Japan Society for Hematopoietic Cell Transplantation. The cumulative incidence of grade II - IV acute GVHD was 33%. Overall survival ( OS) at 5 and 10 years was 48.8 and 42.5%, respectively. Multivariate analyses identified karyotype, FAB classification, and the history of chemotherapy before allo- SCT as significant predictors for OS. OS at 5 years was 57% for patients who underwent allo- SCT as a primary treatment for refractory anemia with excess blasts in transformation ( RAEB- t) or secondary acute myeloid leukemia ( AML) and 54% for those who underwent allo- SCT in remission after induction chemotherapy ( P = 0.81). The proportion of patients with a poor karyotype was equivalent between the two groups ( P = 0.44). Although only a randomized controlled trial will be able to establish a definite conclusion, these results do not support the administration of induction chemotherapy for patients with RAEB- t or secondary AML before allo- SCT.