Decitabine-Containing Conditioning Regimen for Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Intermediate- and High-Risk Myelodysplastic Syndrome/Acute Myeloid Leukemia: Potential Decrease in the Incidence of Acute Graft versus Host Disease

Figures & data

Table 1 Between-Group Differences of Baseline Characteristics

	Dec	Non-Dec	P Value
Total	40	36
Age at HSCT (years)	41±12	33±14	0.028
Gender
Male	20(50%)	17(47%)	0.809
Female	20(50%)	19(53%)
Therapy before transplantation
Chemotherapy	24(60%)	16(44.5%)	0.093
Cyclosporin A	5(12.5%)	12(33.3%)
No	11(27.5%)	8(22.2%)
WHO classification
RA	0(0%)	1(2.8%)	0.299
RCMD	8(20%)	13(36.1%)
RAEB-1	8(20%)	3(8.3%)
RAEB-2	7(17.5%)	5(13.9%)
t-AML	17(42.5%)	14(38.9%)
IPSS-R
Intermediate	8(20%)	15(41.7%)	0.092
High	14(35%)	7(19.4%)
Higher	18(45%)	14(38.9%)
HCT-CI
0–2	25(62.5%)	19(52.8%)	0.391
≥3	15(37.5%)	17(47.2%)
Disease course before transplantation(months)
≤12months	27(67.5%)	28(77.8%)	0.317
>12months	13(32.5%)	8(22.2%)
Bone marrow blasts before transplantation
≤5%	30(75%)	25(69.4%)	0.589
>5%	10(25%)	11(30.6%)
Type of donor
MSD-HSCT	11(27.5%)	9(25%)	0.956
Haplo-HSCT	22(55%)	21(58.3%)
MUD-HSCT	7(17.5%)	6(16.7%)
Graft source
BM+PB	30(75%)	29(80.6%)	0.562
PB	10(25%)	7(19.4%)
MNC(×10^8/kg)	9.76±3.37	12.48±5.07	0.007
CD34+(×10^6/kg)	5.77±2.73	3.65±3.10	0.004
Donor age (years)	33±13	35±10	0.357
Donor/recipient gender
Female to male	10(25%)	4(11.1%)	0.147
Others	30(75%)	32(88.9%)
ABO compatibility
Matched	23(57.5%)	29(80.6%)	0.055
Major mismatched	8(20%)	4(11.0%)
Minor mismatched	8(20%)	1(2.8%)
Major and minor mismatched	1(2.5%)	2(5.6%)
Conditioning regimen
Bu/Flu	40(100%)	31(86.1%)	0.015
Bu/Cy	0(0%)	5(13.9%)
ATG (g/kg)
Yes	39(97.5%)	31(86.1%)	0.066
No	1(2.5%)	5(13.9%)

Abbreviations: RA, refractory anemia; RCMD, refractory cytopenia with multilineage dysplasia; RAEB, refractory anemia with excess blasts; t-AML, transferred acute myeloid leukemia; IPSS-R, Revised international prognostic scoring system; HCT-CI, hematopoietic cell transplant-comorbidity index; MSD-HSCT, HLA-matched sibling donor allogeneic hematopoietic stem cell; Haplo-HSCT, HLA-haploidentical allogeneic hematopoietic stem cell transplantation; MUD-HSCT, HLA-matched unrelated donor allogeneic hematopoietic stem cell transplantation; BM, bone marrow; PB, peripheral blood; Bu, Busulfan; Flu, fludarabine; Cy, cyclophosphamide; ATG, anti-thymocyte globulin.

Table 2 Between-Group Differences of Transplantation-Related Complications Incidence

	Dec	Non-Dec	P Value
CMV viremia	30% (12/40)	53% (19/36)	0.044
EBV viremia	13% (5/40)	17% (6/36)	0.606
Respiratory infection	22.5% (9/40)	53% (19/30)	0.006
Hemorrhagic cystitis	20% (8/40)	17% (6/36)	0.708

Abbreviations: CMV, cytomegalovirus; EBV, Epstein-Barr virus.

Figure 1 Incidence of (A) aGvHD and (B) cGvHD in the Dec group and the non-Dec group.

Abbreviations: HSCT, hematopoietic stem cell transplantation; aGvHD, acute graft versus host disease; cGvHD, chronic graft versus host disease.

Table 3 Univariate Analysis for II to IV Acute Graft versus Host Disease

	P Value
Age at transplantation (≤40years/>40years)	0.018
Gender (male/female)	0.918
Treatment before transplantation (chemotherapy/immunosuppression/no)	0.399
WHO classification (RA/RCMD/RAEB1/RAEB2/t-AML)	0.561
IPSS-R (intermediate/high/higher)	0.293
HCT-CI (0–2/≥3)	0.440
Disease course before transplantation (≤12months/>12months)	0.362
BM blasts before transplantation (≤5%/>5%)	0.952
Donor type (MSD/Haplo/MUD)	0.065
Graft source (BM+PB/PB)	0.677
MNC (≤9.8×10^8/kg, >9.8×10^8/kg)	0.125
CD34+ (≤3.7×10^6/kg, >3.7×10^6/kg)	0.197
Donor age (<35 years/≥35 years)	0.362
Donor/recipient gender (female donor to male recipient/others)	0.684
ABO compatibility (matched/major mismatched/minor mismatched/major and minor mismatched)	0.167
Conditioning regimen (Bu/Flu, Bu/Cy)	0.451
ATG (Yes/No)	0.824
CMV viremia (Yes/No)	0.139
Respiratory infection (Yes/No)	0.152

Abbreviations: RA, refractory anemia; RCMD, refractory cytopenia with multilineage dysplasia; RAEB, refractory anemia with excess.

Table 4 Multivariate Analysis for Acute Graft versus Host Disease

	P Value	HR (95% CI)
Dec (yes/no)	0.013	0.279 (0.102–0.765)
Age at transplantation (≤40years/>40years)	0.150	0.487 (0.185–1.285)
Donor type (MSD/other types)	0.180	1.430 (0.846–2.417)

Abbreviations: OR, odds ratio; CI, confidence interval; HCT-CI=hematopoietic cell transplant-comorbidity index; MSD-HSCT=HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation; BM=bone marrow; PB=peripheral blood; ATG=anti-thymocyte globulin.

Figure 2 Differences of (A) overall survival (OS), (B) disease-free survival (DFS), (C) relapse rate (RR) and (D) no relapse mortality (NRM) between the Dec group and the non-Dec group of IPSS-R higher-risk patients.

Abbreviations: HSCT, hematopoietic stem cell transplantation; IPSS, international prognostic scoring system.