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3538 Granulocyte Colony-Stimulating Factor and Decitabine-Containing Conditioning Improves Survival in Myelodysplastic Syndrome Patients with Iron Overload Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Program: Oral and Poster Abstracts
Session: 721. Allogeneic Transplantation: Conditioning Regimens, Engraftment and Acute Toxicities: Poster II
Hematology Disease Topics & Pathways:
Iron Overload, Combination therapy, Diseases, Therapies, Metabolic Disorders
Sunday, December 10, 2023, 6:00 PM-8:00 PM

Wenshu Zhao1*, Danqi Pan2*, Xiangzong Zeng3*, Li Xuan2*, Zhiping Fan4*, Fen Huang5*, Na Xu2*, Jing Sun, Mphil, BEng6*, Qifa Liu, MD4 and Min Dai, MD7*

1Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, AL, China
2Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
3Institute of Digestive Disease, the Sixth Affiliated Hospital of Guangzhou Medic, Qingyuan, CHN
4Nanfang Hospital, Southern Medical University, Guangzhou, China
5Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, CHN
6Nanfang hospital of southern medical university, guangzhou, China
7Nanfang Hospital Southern Medical University, Guangzhou, China

Background: Iron overload is considered as an unfavorable prognosis in myelodysplastic syndrome (MDS) even in those undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although iron chelation therapy has improved the prognosis of these patients to some extent, the effect has not yet been satisfactory. This study aimed to investigate whether granulocyte colony-stimulating factor and decitabine (G-DAC)-containing conditioning improve the prognosis of iron-overloaded MDS patients undergoing allo-HSCT.

Study Design: One hundred and ninety-seven patients were enrolled in this retrospective study. Based on the level of serum ferritin (SF) and conditioning regimen, all patients enrolled were divided into 4 groups: SF﹤1000µg/L with G-DAC conditioning (cohort 1), SF﹤1000µg/L with non-G-DAC conditioning (cohort 2), SF ≥ 1000µg/L with G-DAC conditioning (cohort 3) and SF ≥ 1000µg/L with non-G-DAC conditioning (cohort 4). The clinical features and prognosis between cohorts were analyzed.

Results: The 2-year overall survival (OS) was 77.0%, 72.1%, 73.8% and 38.7% (P = 0.001), and disease-free survival (DFS) was 75.7%, 62.8%, 71.7% and 35.5% (P = 0.001), and the cumulative incidence of non-relapse mortality (NRM) was 17.3%, 25.0%, 15.2% and 53.1% (P = 0.001), and the incidence of relapse was 8%, 13.6%, 13.1% and 12.5% (P = 0.592), respectively, in the four groups. To be specific, cohort4 had worse OS and DFS and higher NRM than the other three groups (all P﹤0.05). Multivariate analysis revealed that SF ≥ 1000µg/L was a risk factor for OS, DFS and NRM (P = 0.022, P = 0.025, P = 0.036), while G-DAC-containin g conditioning was a protective factor (P = 0.009, P = 0.003, P = 0.004). Intriguingly, when cohort 1 to cohort4 were included in the multivariate analysis, only cohort4 was a risk factor for OS, DFS and NRM (all P﹤0.05), but cohort3, namely iron-overloaded patients who received G-DAC-containing conditioning had no difference in prognosis compared with patients with SF﹤1000µg/L.

Conclusions: The poor prognosis of patients with iron overload could be overcome by G-DAC-containing conditioning partly.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH