The MDS Beacon™

Researchers from the United States and Spain recently found that lower-risk myelodysplastic syndromes patients may benefit from early treatment with a certain kind of stem cell transplant.

Specifically, the patients benefited from donor stem cell transplants without T-cells, a type of white blood cell.

Over 60 percent of patients experienced survival times greater than five years, and the rate of graft-versus-host disease, a common transplant-related complication, was low.

According to the researchers, these findings support the use of transplantation without T-cells in lower-risk myelodysplastic syndromes (MDS) patients.

The findings were presented at the 2011 American Society of Hematology (ASH) meeting last month.

Donor stem cell transplantation, also called allogeneic stem cell transplantation, is the only curative treatment for patients with MDS. However, this treatment is typically not considered early in the treatment plan for patients with lower-risk MDS due to the high risk of transplant-related complications.

Graft-versus-host disease is a common transplant-related complication, in which the donated stem cells attack the body’s cells. The rate of graft-versus-host disease decreases if mature T cells are removed from the donor cells before they are transplanted. T cells are a type of white blood cell that helps fight infections and tumor cells. They have also been identified as a cause of transplant rejection.

In the present study, researchers evaluated survival outcomes of 44 lower-risk MDS patients who underwent T cell-depleted stem cell transplantation early in their treatment plan. The median patient age was 37 years, and the median time from diagnosis to transplant was 0.6 years.

Prior to transplantation, patients received chemotherapy, with or without high-dose total body irradiation. Most of the patients also received anti-thymocyte globulin as preventative treatment for graft rejection. For 55 percent of patients, the transplant donor was a sibling, whereas 45 percent underwent transplantation with an unrelated donor.

The researchers found that the donated stem cells started producing white blood cells, a sign of a successful transplant, a median of 11 days after the transplant.

Five patients experienced graft failure, in which the body does not accept the donated cells. Four of these patients received second transplants, the common treatment for this complication.

The two-year and five-year survival rates were 70.1 percent and 63.3 percent, respectively.

Of the 44 patients included in the study, 14 percent developed graft-versus-host disease; half of the cases developed within the first 100 days after the transplant, the other half developed more than 100 days after the transplant.

As of May 2011, 36 percent of patients had died. Their causes of death included graft-versus-host disease (11 percent of patients), infections (11 percent), graft failure or poor graft function (7 percent), side effects of the preparative therapy prior to transplantation (5 percent), and lung cancer (2 percent).

For more information, please see abstract 3831 at the ASH 2011 meeting website.