In a systematic review and meta-analysis, we compared allogeneic transplant outcomes after myeloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) in patients with myelodysplastic syndromes. Only 2 published randomized clinical trials were found, with a pooled sample size of 183 (RIC, 92; MAC, 91). Both studies suggested an overall survival advantage after RIC, with a pooled hazard ratio (HR) of. 67 (95% confidence interval [CI],. 41 to 1.09) for RIC versus MAC. Relapse results were also concordant, with a pooled HR of 1.55 (95% CI,. 74 to 3.25) for RIC versus MAC. Neither result was statistically significant. Comparisons for other outcomes were unremarkable. In conclusion, the evidence for the optimal conditioning intensity in myelodysplastic syndromes is weak. Post-transplant maintenance strategies and incorporation of genomic information into decision-making may improve post-transplant outcomes.
Bibliographical noteFunding Information:
Financial disclosure: The authors have nothing to disclose. Conflict of interest statement: M.H. reports research support/funding from Takeda Pharmaceutical Company, Otsuka Pharmaceutical, Spectrum Pharmaceuticals, and Astellas Pharma; consultant for Janssen R&D, Incyte Corporation, ADC Therapeutics, Celgene Corporation, Pharmacyclics, Magenta Therapeutics, Omeros, AbGenomics, Verastem, and TeneoBio; speaker's bureau for Sanofi Genzyme and AstraZeneca. Authorship statement: A.R. and M.H. designed the study. A.R. M.A.M. and W.C. wrote the manuscript. M.A.M. conducted the literature search. M.A.M. and A.R. extracted the data. W.C. and H.C. performed the meta-analysis. E.D.W. S.D. M.C.P. D.J.W. and M.H. critically evaluated the results and manuscript. Financial disclosure: See Acknowledgments on page e141.
© 2020 American Society for Transplantation and Cellular Therapy
- Myelodysplastic syndromes
- Reduced intensity
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
- Systematic Review