FACTORS INFLUENCING OUTCOME IN DE-NOVO MYELODYSPLASTIC SYNDROMES TREATED BY ALLOGENEIC BONE-MARROW TRANSPLANTATION - A LONG-TERM STUDY OF 71 PATIENTS

We report on 71 consecutive patients with de novo myelodysplastic synd romes referred to physicians belonging to the Societe francaise de gre ffe de moelle from 1982 through 1991 and transplanted with marrow from HLA-identical siblings. There were 16 cases of refractory anemia, 27 of refractory anemia with excess of blast cells, and 28 of refractory anemia with excess of blast cells in transformation. Seventeen patient s had received cytoreductive chemotherapy before the graft. The diseas e progressed in 17 patients between diagnosis and grafting. Twenty-thr ee patients are alive with a median follow-up of 6 years, whereas 24 d ied from relapse and 24 from transplant-related complications. Kaplan- Meier estimates of event-free survival, relapse and transplant-related mortality at 7 years were 32%, 48%, and 39%, respectively. The log-ra nk test and Cox's model revealed better outcome among young patients, patients in an early stage of the French-American-British (FAB) classi fication or with a low percentage of marrow blasts before transplantat ion, patients who did not undergo cytoreductive chemotherapy before tr ansplantation, and patients conditioned with total body irradiation an d cyclophosphamide. The high rate of relapse in advanced FAB stages ha s led us to graft patients earlier in the course of the disease, and w e are currently conducting a multicenter, randomized study to determin e the value of intensive chemotherapy before grafting in patients with an excess of marrow blasts. (C) 1996 by The American Society of Hemat ology.