Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel

Theo De Witte, David Bowen, Marie Robin, Luca Malcovati, Dietger Niederwieser, Ibrahim Yakoub-Agha, Ghulam J. Mufti, Pierre Fenaux, Guillermo Sanz, Rodrigo Martino, Emilio Paolo Alessandrino, Francesco Onida, Argiris Symeonidis, Jakob Passweg, Guido Kobbe, Arnold Ganser, Uwe Platzbecker, Jürgen Finke, Michel Van Gelder, Arjan A. Van De Loosdrecht & 10 others Per Ljungman, Reinhard Stauder, Liisa Volin, H. Joachim Deeg, Corey Cutler, Wael Saber, Richard Champlin, Sergio Giralt, Claudio Anasetti, Nicolaus Kröger

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.

Original languageEnglish
Pages (from-to)1753-1762
Number of pages10
JournalBlood
Volume129
Issue number13
DOIs
Publication statusPublished - 30 Mar 2017

Cite this

De Witte, T., Bowen, D., Robin, M., Malcovati, L., Niederwieser, D., Yakoub-Agha, I., ... Kröger, N. (2017). Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel. Blood, 129(13), 1753-1762. https://doi.org/10.1182/blood-2016-06-724500
De Witte, Theo ; Bowen, David ; Robin, Marie ; Malcovati, Luca ; Niederwieser, Dietger ; Yakoub-Agha, Ibrahim ; Mufti, Ghulam J. ; Fenaux, Pierre ; Sanz, Guillermo ; Martino, Rodrigo ; Alessandrino, Emilio Paolo ; Onida, Francesco ; Symeonidis, Argiris ; Passweg, Jakob ; Kobbe, Guido ; Ganser, Arnold ; Platzbecker, Uwe ; Finke, Jürgen ; Van Gelder, Michel ; Van De Loosdrecht, Arjan A. ; Ljungman, Per ; Stauder, Reinhard ; Volin, Liisa ; Deeg, H. Joachim ; Cutler, Corey ; Saber, Wael ; Champlin, Richard ; Giralt, Sergio ; Anasetti, Claudio ; Kröger, Nicolaus. / Allogeneic hematopoietic stem cell transplantation for MDS and CMML : Recommendations from an international expert panel. In: Blood. 2017 ; Vol. 129, No. 13. pp. 1753-1762.
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title = "Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel",
abstract = "An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10{\%} bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.",
author = "{De Witte}, Theo and David Bowen and Marie Robin and Luca Malcovati and Dietger Niederwieser and Ibrahim Yakoub-Agha and Mufti, {Ghulam J.} and Pierre Fenaux and Guillermo Sanz and Rodrigo Martino and Alessandrino, {Emilio Paolo} and Francesco Onida and Argiris Symeonidis and Jakob Passweg and Guido Kobbe and Arnold Ganser and Uwe Platzbecker and J{\"u}rgen Finke and {Van Gelder}, Michel and {Van De Loosdrecht}, {Arjan A.} and Per Ljungman and Reinhard Stauder and Liisa Volin and Deeg, {H. Joachim} and Corey Cutler and Wael Saber and Richard Champlin and Sergio Giralt and Claudio Anasetti and Nicolaus Kr{\"o}ger",
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De Witte, T, Bowen, D, Robin, M, Malcovati, L, Niederwieser, D, Yakoub-Agha, I, Mufti, GJ, Fenaux, P, Sanz, G, Martino, R, Alessandrino, EP, Onida, F, Symeonidis, A, Passweg, J, Kobbe, G, Ganser, A, Platzbecker, U, Finke, J, Van Gelder, M, Van De Loosdrecht, AA, Ljungman, P, Stauder, R, Volin, L, Deeg, HJ, Cutler, C, Saber, W, Champlin, R, Giralt, S, Anasetti, C & Kröger, N 2017, 'Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel' Blood, vol. 129, no. 13, pp. 1753-1762. https://doi.org/10.1182/blood-2016-06-724500

Allogeneic hematopoietic stem cell transplantation for MDS and CMML : Recommendations from an international expert panel. / De Witte, Theo; Bowen, David; Robin, Marie; Malcovati, Luca; Niederwieser, Dietger; Yakoub-Agha, Ibrahim; Mufti, Ghulam J.; Fenaux, Pierre; Sanz, Guillermo; Martino, Rodrigo; Alessandrino, Emilio Paolo; Onida, Francesco; Symeonidis, Argiris; Passweg, Jakob; Kobbe, Guido; Ganser, Arnold; Platzbecker, Uwe; Finke, Jürgen; Van Gelder, Michel; Van De Loosdrecht, Arjan A.; Ljungman, Per; Stauder, Reinhard; Volin, Liisa; Deeg, H. Joachim; Cutler, Corey; Saber, Wael; Champlin, Richard; Giralt, Sergio; Anasetti, Claudio; Kröger, Nicolaus.

In: Blood, Vol. 129, No. 13, 30.03.2017, p. 1753-1762.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Allogeneic hematopoietic stem cell transplantation for MDS and CMML

T2 - Recommendations from an international expert panel

AU - De Witte, Theo

AU - Bowen, David

AU - Robin, Marie

AU - Malcovati, Luca

AU - Niederwieser, Dietger

AU - Yakoub-Agha, Ibrahim

AU - Mufti, Ghulam J.

AU - Fenaux, Pierre

AU - Sanz, Guillermo

AU - Martino, Rodrigo

AU - Alessandrino, Emilio Paolo

AU - Onida, Francesco

AU - Symeonidis, Argiris

AU - Passweg, Jakob

AU - Kobbe, Guido

AU - Ganser, Arnold

AU - Platzbecker, Uwe

AU - Finke, Jürgen

AU - Van Gelder, Michel

AU - Van De Loosdrecht, Arjan A.

AU - Ljungman, Per

AU - Stauder, Reinhard

AU - Volin, Liisa

AU - Deeg, H. Joachim

AU - Cutler, Corey

AU - Saber, Wael

AU - Champlin, Richard

AU - Giralt, Sergio

AU - Anasetti, Claudio

AU - Kröger, Nicolaus

PY - 2017/3/30

Y1 - 2017/3/30

N2 - An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.

AB - An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.

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U2 - 10.1182/blood-2016-06-724500

DO - 10.1182/blood-2016-06-724500

M3 - Review article

VL - 129

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EP - 1762

JO - Blood

JF - Blood

SN - 0006-4971

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De Witte T, Bowen D, Robin M, Malcovati L, Niederwieser D, Yakoub-Agha I et al. Allogeneic hematopoietic stem cell transplantation for MDS and CMML: Recommendations from an international expert panel. Blood. 2017 Mar 30;129(13):1753-1762. https://doi.org/10.1182/blood-2016-06-724500