Hematopoietic Stem Cell Transplant in Older Patients with MDS and Co-existing Myelofibrosis

Background: Myelodysplastic syndrome with co-existing bone marrow fibrosis is associated with a dismal prognosis with conventional therapy. Allogeneic hematopoietic stem cell transplant (HSCT) offers the sole treatment approach that offers curative potential. HSCT has been utilized in younger patients with this disorder however with the advent of reduced intensity conditioning (RIC) regimens it has allowed for expansion of this application up to the age of 70 years. The data on the outcomes of patients of older age undergoing RIC for MDS with fibrosis is unknown. Methods: To identify patients who received HSCT at our center with the diagnosis of myelodysplastic syndrome with co-existing fibrosis (n=15). We conducted a retrospective review in regards to HSCT specific variables influencing outcome and classified them according to their age, degree of bone marrow fibrosis, cytogenetic abnormality, Jak2, engraftment, transplant-related mortality, relapse and overall survival. Results: Higher median age, high risk cytogenetics and high grade bone marrow fibrosis in our study population was not associated with inferior survival in univariate analysis. The cumulative incidence of engraftment achieved at day+30 based on chimerism was 72.7% the 2-year overall survival was 78% in the patient cohort. There were no patients who developed graft failure and no reported cases of relapse posttransplant. Conclusions: Among patients with myelodysplastic syndrome and co-existing bone marrow fibrosis, even in patients with older age, higher grade of marrow fibrosis or cytogenetic abnormality, overall survival after hematopoietic stem cell transplantation was not inferior. HSCT should be offered to patients even with older age and significant marrow fibrosis. Citation: Saste Abhijit, Meredith Mahan, Nalini Janakiraman, Shatha Farhan, Susan Michalowski, Edward Peres (2017). Hematopoietic Stem Cell Transplant in Older Patients with MDS and Co-existing Myelofibrosis Page 2 of 3 www.scientonline.org J Blood Disord Symptoms Treat Volume 1 • Issue 1 • 004 for patients with MDS are certain cytogenetic characteristics, number of blasts, and status of the disease at time of transplant, donor source and age of the patient at time of transplant. Data in regards to the impact of bone marrow fibrosis on outcome after allogeneic stem cell transplantation in patients with MDS especially over the age of 60 are limited. Here in we report the outcome of patients who underwent HSCT at our institution with MDS and co-existing bone marrow fibrosis.