BONE-MARROW TRANSPLANTATION FROM HLA IDENTICAL SIBLINGS AS FIRST-LINETREATMENT IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES - EARLY TRANSPLANTATION IS ASSOCIATED WITH IMPROVED OUTCOME

Allogeneic bone marrow transplantation (BMT) offers a potential cure f or younger patients with myelodysplastic syndromes (MDS) or secondary acute myeloid leukemia (sAML), More than 600 patients from 50 European centers have now been reported to the European Group for Blood and Ma rrow Transplantation (EBMT). We retrospectively analyzed 131 patients reported to the Chronic Leukemia Working Party of the EBMT who underwe nt BMT from HLA-identical siblings without prior remission induction c hemotherapy, At the time of BMT 46 patients had refractory anemia (RA) or RA with ringed sideroblasts, 67 patients had more advanced MDS sub types and 18 patients had progressed to sAML. The 5-year disease-free (DFS) and overall survival (OS) for the entire group of patients was 3 4 and 41%, respectively, Fifty patients died from transplant-related c omplications, most commonly graft-versus-host disease and/or infection s, Relapse occurred in 28 patients between 1 and 33 months after BMT, resulting in an actuarial probability of relapse of 39% at 5 years, DF S and OS were dependent on pretransplant bone marrow blast counts, Pat ients with RA/RARS, RAEB, RAEB/T and sAML had a 5-year DFS of 52, 34, 19 and 26%, respectively, The 5-year OS for the respective patient gro ups, was 57, 42, 24 and 28%, In a multivariate analysis, younger age, shorter disease duration, and absence of excess of blasts were associa ted with improved outcome, From these data we conclude that patients w ith myelodysplasia who have appropriate marrow donors, especially thos e aged less than 40 Sears and those with low medullary blast cell coun t should be treated with BMT as the primary treatment early in the cou rse of their disease, Transplantation early after establishing the dia gnosis of MDS may improve prognosis due to a lower treatment-related m ortality and a lower relapse risk.