Can Early Transplant Be Used for Patients with Low-Risk MDS?

By Guillermo Garcia-Manero, MD, Sangeetha Venugopal, MD, George Yaghmour, MD, Jamie Koprivnikar, MD - Last Updated: December 18, 2023

A roundtable discussion, moderated by Guillermo Garcia-Manero, MD, Blood Cancers Today Associate Editor, of the University of Texas MD Anderson Cancer Center, focused on the latest data in the treatment of low-risk myelodysplastic syndromes. Dr. Garcia-Manero was joined by Jamie Koprivnikar, MD; George Yaghmour, MD; and Sangeetha Venugopal, MD.

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In the next segment of the roundtable series, the panel talks about the use of transplant for patients with low-risk myelodysplastic syndromes.

Watch the next segment in this series.

Dr. Garcia-Manero: To close, you are also a transplanter, I’m not. I don’t know if Jamie does.

Dr. Koprivnikar: I don’t do any transplants.

Dr. Garcia-Manero: But this is something that I think Sangeetha was talking about how this IPSS-M [Molecular International Prognostic Scoring System] has kind of resulted in this upstaging or some of these lower-risk patients into intermediate/high. We’ve never transplanted lower-risk patients. Indeed, the American Society for Transplantation and Cellular Therapy doesn’t recommend it, but do you see that all these kind of changes will maybe find a niche or a role for early transplant in patients with low-risk MDS [myelodysplastic syndromes]?

Dr. Yaghmour: Very great question that I have to answer at least two or three times a week in my clinic. Yesterday I had the discussion with my patient and team. Yes, we have data that’s still controversial based on if you have low-risk MDS and we know that patient population is always older age and carry comorbidity and there is non-relapse mortality up to 30% from the transplant. Overall, the focus is the overall survival. Knowing from CIBMTR [Center for International Blood and Marrow Transplant Research] data that said overall survival from transplant outcome using non-myeloablative and reduced intensity, that has improved the overall survival. Commenting on the ASH data that if we use the molecular scoring system, we observed that patients who were on the intermediate risk by IPSS, 20% of them, benefited by overall survival by delaying transplant having with additional information still 19%. If they transplanted earlier on that data, they got the survival benefit.

That would tell us of course if we have more molecular mutation data that we see with our patient population, including not just TP53 mutation because deletion 5q, now we know there is data showing us there is a new way to categorize those patients, 5q with TP53 or without TP53, regardless of the blast count. In my opinion as a transplanter that I do over 30 transplants a year at least. I tell my patients based on the overall scoring system and donor availability, that if you do the… don’t include the molecular mutation and basically they are not in the very low and low and they’re in intermediate risk. Having those bad player mutation offering allogeneic transplant, which has remained the only cure with non-relapse mortality. If you have a good matched donor in the setting of using T-cell depletion, you have survival benefit for this patient population.

But if they don’t carry that scoring, that would make us talking about those 20% patient that will have better survival if you don’t do the transplant. The time of transplant matters sometimes for this case to remain at controversy and based on the institution survival data and patient preference and comorbidity still would like to have more confirmatory data.

Post Tags:MDS Roundtable
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