Results of an analysis show that early stem cell transplantation with reduced-intensity chemotherapy provides a survival benefit for older patients with higher-risk myelodysplastic syndromes, but not for those with lower-risk disease.

The study authors concluded that early transplantation is not an appropriate treatment strategy for older, lower-risk patients unless quality of life is significantly impaired.

The findings were presented at the 2011 American Society of Hematology (ASH) annual meeting in San Diego on Sunday.

Donor stem cell transplantation is currently the only available cure for myelodysplastic syndromes (MDS). Patients undergo chemotherapy to destroy cancerous cells and then receive healthy stem cells from a donor to replace the patients’ stem cells that were destroyed during chemotherapy. Older patients frequently receive lower doses of chemotherapy, called reduced-intensity chemotherapy, to reduce the severity of treatment-related side effects.

Researchers designed a computer model to determine the role of donor stem cell transplantation with reduced-intensity chemotherapy in older MDS patients. They compared the survival outcomes of 92 older patients between the ages of 60 and 70 years who underwent reduced-intensity chemotherapy and transplantation to those of patients with similar levels of disease risk who did not receive transplants. The data for the comparison groups were provided from other clinical trials.

For older patients with lower-risk MDS, the overall survival was 38 months for those who underwent transplantation and 77 months for those who instead received best supportive care or growth factors.

They also found that for transfusion-independent patients, the expected survival was 35 months for the transplanted group and 65 months for the non-transplanted group. For transfusion-dependent patients, the expected survival was 35 months for the transplanted group and 46 months for the non-transplanted group.

For older patients with higher-risk MDS, the overall survival was higher for patients who received an early transplant (36 months), compared to patients who received treatment with Vidaza (azacitidine) or Dacogen (decitabine) (28 months).

For more information, please see abstract 115 at the ASH 2011 meeting website.

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