Sequential vs myeloablative vs reduced intensity conditioning for patients with myelodysplastic syndromes with an excess of blasts at time of allogeneic haematopoietic cell transplantation: a retrospective study by the chronic malignancies working party of the EBMT

Research output: Contribution to journalResearch articleContributedpeer-review


  • V Potter - , Kings College Hospital NHS Foundation Trust (Author)
  • L Gras - , EBMT Statistical Unit (Author)
  • L Koster - , EBMT Leiden Study Unit (Author)
  • N Kroger - , University Hospital Hamburg Eppendorf (Author)
  • K Sockel - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • A Ganser - , Hannover Medical School (MHH) (Author)
  • J Finke - , Protestant University of Applied Sciences Freiburg (Author)
  • H Labussiere-Wallet - , Centre Hospitalier Lyon Sud (Author)
  • R Peffault de Latour - , Hôpital Saint-Louis (Author)
  • Y Koc - , Medicana International Hospital Istanbul (Author)
  • U Salmenniemi - , HUCH Comprehensive Cancer Center (Author)
  • L Smidstrup Friis - , Bone Marrow Transplant Unit L 4043 (Author)
  • P Jindra - , University Hospital Motol (Author)
  • T Schroeder - , LVR University Hospital Essen (Author)
  • J Tischer - , Klinikum Grosshadern (Author)
  • M Arat - , Demiroglu Bilim University Istanbul Florence Nightingale Hospital (Author)
  • M Pascual Cascon - , Hospital Regional de Málaga (Author)
  • L C de Wreede - , Leiden University (Author)
  • P Hayden - , Trinity College Dublin (Author)
  • K Raj - , University College London Hospitals NHS Foundation Trust (Author)
  • J Drozd-Sokolowska - , Medical University of Warsaw (Author)
  • C Scheid - , Uniklinik Köln (Author)
  • D P McLornan - , University College London Hospitals NHS Foundation Trust (Author)
  • M Robin - , Hôpital Saint-Louis (Author)
  • I Yakoub-Agha - , CHU de Lille (Author)


The optimal conditioning for patients with higher risk MDS receiving potentially curative allogeneic haematopoietic stem cell transplant(allo-HCT) remains to be defined. This is particularly the case for patients with excess of blasts at time of allo-HCT. Sequential (Seq) conditioning, whereby chemotherapy is followed rapidly by transplant conditioning, offers an opportunity to decrease disease burden, potentially improving outcomes allo-HCT outcomes. Herein we present the only analysis comparing Seq to myeloablative (MAC) and reduced intensity conditioning (RIC) specifically focussed on MDS patients with excess of blasts at allo-HCT. 303 patients were identified in the EBMT registry, receiving RIC (n = 158), Seq (n = 105), and MAC (n = 40). Median follow-up was 67.2 months and median age at allo-HCT was 59.5 years (IQR 53.5-65.6). For the entire cohort, 3 y overall survival (OS) was 50% (95% CI 45-56%) and relapse free survival (RFS) 45% (95% CI 40-51%). No significant differences in OS (log-rank p = 0.13) and RFS (log-rank p = 0.18) were observed between conditioning protocols. On multivariable analysis, lower performance status, worse IPSS-R cytogenetics, sibling donor (compared to 8/8 MUD) and ≥20% blasts at allo-HCT were associated with worse outcomes. In conclusion, the Seq protocol did little to influence the outcome in this high-risk group of patients, with outcomes mostly determined by baseline disease risk and patient characteristics such as performance status.


Original languageEnglish
JournalBone marrow transplantation
Publication statusE-pub ahead of print - 22 Nov 2023

External IDs

Scopus 85177460879