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<p>Myelodysplastic syndromes (MDS) can progress to AML and often require allogeneic hematopoietic stem cell transplantation (allo-SCT). The sequential FLAMSA-FB regimen, featuring a cytoreductive FLAMSA phase followed by fludarabine-busulfan (FB) conditioning, may enhance disease control. We retrospectively analyzed 106 untreated MDS patients with blasts 5–19% at the University Medical Center Hamburg who received either FLAMSA-FB (<i>n</i> = 45) or standard conditioning (<i>n</i> = 61: Thiotepa-Busulfan (<i>n</i> = 30), Fludarabine-Busulfan (<i>n</i> = 16), Treosulfan-Fludarabine (<i>n</i> = 15)). Median follow-up was 24 months. The FLAMSA group was younger (median age 56 vs. 62, <i>p</i> = 0.02), but baseline IPSS risk scores (<i>p</i> = 0.16) and donor types (<i>p</i> = 0.43) were comparable. Engraftment rates were similar. At two years, overall survival (OS) was 62% with FLAMSA and 68% with standard conditioning (<i>p</i> = 0.92), while progression-free survival (PFS) was 56% vs. 59% (<i>p</i> = 0.92). Non-relapse mortality (22% vs. 25%, <i>p</i> = 0.78) and cumulative incidence of relapse (22% vs. 13%, <i>p</i> = 0.12) did not differ significantly, nor did grade II–IV acute graft-versus-host disease (GVHD). Propensity score matching in 18 pairs confirmed no significant differences in OS, PFS, NRM, or CIR. However, moderate-to-severe chronic GVHD was higher with FLAMSA-FB (50% vs. 17%, <i>p</i> = 0.04). Thus, FLAMSA-FB did not improve transplant outcomes over standard conditioning but was linked to an increased risk of chronic GVHD.</p>

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Sequential versus standard conditioning in untreated MDS patients with blasts undergoing allogeneic HSCT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月1日

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  • Radwan Massoud,
  • Evgeny Klyuchnikov,
  • Normann Steiner,
  • Maroly Bohorquez Manjarres,
  • Gaby Zeck,
  • Rolf Krause,
  • Silke Heidenreich,
  • Claudia Langebrake,
  • Adrin Dadkhah,
  • Ina Rudolph,
  • Rusudan Sabauri,
  • Christian Niederwieser,
  • Tetiana Perekhrestenko,
  • Mirjam Reichard,
  • Mathias Schäfersküpper,
  • Franziska E. Marquard,
  • Sofia Oechsler,
  • Gunnar Weise,
  • Kristin Rathje,
  • Maraike Harfmann,
  • Nico Gagelmann,
  • Catherina Lück,
  • Christine Wolschke,
  • Francis Ayuk,
  • Nicolaus Kröger

摘要

Myelodysplastic syndromes (MDS) can progress to AML and often require allogeneic hematopoietic stem cell transplantation (allo-SCT). The sequential FLAMSA-FB regimen, featuring a cytoreductive FLAMSA phase followed by fludarabine-busulfan (FB) conditioning, may enhance disease control. We retrospectively analyzed 106 untreated MDS patients with blasts 5–19% at the University Medical Center Hamburg who received either FLAMSA-FB (n = 45) or standard conditioning (n = 61: Thiotepa-Busulfan (n = 30), Fludarabine-Busulfan (n = 16), Treosulfan-Fludarabine (n = 15)). Median follow-up was 24 months. The FLAMSA group was younger (median age 56 vs. 62, p = 0.02), but baseline IPSS risk scores (p = 0.16) and donor types (p = 0.43) were comparable. Engraftment rates were similar. At two years, overall survival (OS) was 62% with FLAMSA and 68% with standard conditioning (p = 0.92), while progression-free survival (PFS) was 56% vs. 59% (p = 0.92). Non-relapse mortality (22% vs. 25%, p = 0.78) and cumulative incidence of relapse (22% vs. 13%, p = 0.12) did not differ significantly, nor did grade II–IV acute graft-versus-host disease (GVHD). Propensity score matching in 18 pairs confirmed no significant differences in OS, PFS, NRM, or CIR. However, moderate-to-severe chronic GVHD was higher with FLAMSA-FB (50% vs. 17%, p = 0.04). Thus, FLAMSA-FB did not improve transplant outcomes over standard conditioning but was linked to an increased risk of chronic GVHD.