Outcomes of Hematopoietic Stem Cell Transplant in Older Patients with Myelodysplastic Syndrome and Co-Existing Myelofibrosis: A Single Center Experience and Review of the Literature

Background:Myelodysplastic syndrome with coexisting bone marrow fibrosis has a dismal prognosis when treated with conventional chemotherapy suggesting that marrow fibrotic grade may be an important prognostic factor. Allogeneic stem cell transplantation (ASCT) has been utilized in young fit patients with this disorder. However outcomes in older patients are unknown.

Design and Methods: We conducted a retrospective study to assess the therapeutic efficacy of ASCT in 11 patients with myelodysplastic syndrome with a known co-existing high grade myelofibrosis (n=11) .Data were classified based on cytogenetic risk, conditioning regimen, donor source and cytoreduction pre-transplant. We evaluated rates of engraftment, graft versus host disease and overall survival.

Results: Higher median age of 66 years, high cytogenetic risk class and high grade bone marrow fibrosis in our study population was not associated with inferior survival in a univariate analysis. There were no patients who developed graft failure. Cumulative incidence of engraftment achieved at day +30 based on chimersim was 72.7%. The 3 year overall survival was 100% when pre-transplant cytoreduction was used. There were no cases of disease relapse.

Conclusions: Among patients with myelodysplastic syndrome and concomitant bone marrow fibrosis, advanced age, a higher grade of fibrosis or cytogenetic complexity did not adversely affect survival after ASCT.This treatment modality should therefore be considered in patients even with advanced age.