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Are syngeneic donors a viable donor option in allogeneic haematopoietic cell transplantation for MDS? A brief report on behalf of the Chronic Malignancies Working Party of the EBMT and review of current literature

Bone Marrow Transplantation volume 58, pages 942–945 (2023)Cite this article

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Myelodysplastic syndrome (MDS) are chronic hematological malignancies characterized by impaired hematopoiesis and an inherent propensity to transform into acute myeloid leukemia (AML). Expected survival after diagnosis can be estimated using international prognostic scores including blood cell counts, marrow blast percentage and cytogenetic risk groups with the addition of somatic mutations in the more recently proposed molecularly-annotated scoring systems [1,2,3]. High risk patients have median survival less than one year without allogeneic hematopoietic cell transplantation (HSCT). HSCT remains the only curative option which has been reported to prolong survival in patients with intermediate-2 or high risk MDS patients in prospective studies [4,5,6].

A HLA matched sibling donor (MSD), in the absence of a germline predisposition syndrome, is usually considered the best donor, but it is also evidenced that an HLA matched unrelated donor gives similar overall survival (OS), and relapse-free survival (RFS), even if non-relapse mortality (NRM) may be higher than in the setting of a MSD [7]. The question of the syngeneic donor in the donor choice algorithm is rarely raised, due to the low probability of having an HLA identical twin donor. However, even if such a donor is available, there is no strong evidence that outcome after HSCT with a syngeneic donor is better than with a different type of donor. For general consideration of syngeneic donor transplantation, due to the complete HLA compatibility, the anticipated graft-versus-disease effect may be abolished, increasing relapse risk and abrogating the benefits of HSCT. Of note, the presence of such an allogeneic effect after syngeneic transplantation is still a matter of debate. For any hematological malignancy, mild GVHD after syngeneic transplantation has indeed been reported and relapse rates are not as high as it would be expected in the absence of a graft-versus-disease effect [8,9,10,11]. In contrast to autologous transplant, syngeneic transplant is not contaminated by leukemic/disease causing cells which avoids relapse arising from the graft [12, 13].

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Fig. 1: Outcomes in MDS patients transplanted from a syngeneic donor.

Data availability

The final analysis dataset will be available upon specific request to the working party chair

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Author information

Authors and Affiliations

  1. Hopital Saint-Louis, APHP, Université de Paris Cité, Paris, France

    Marie Robin

  2. EBMT Statistical Unit, Leiden, the Netherlands

    Luuk Gras

  3. EBMT Leiden Study Unit, Leiden, the Netherlands

    Linda Koster

  4. Azienda Ospedaliera Universitaria Careggi, Firenze, Italy

    Riccardo Saccardi

  5. University of Freiburg, Freiburg, Germany

    Jürgen Finke

  6. CHU Bordeaux, Pessac, France

    Edouard Forcade

  7. Hospital Clinic, Barcelona, Spain

    Montserrat Rovira

  8. University Hospital Düsseldorf, Department of Hematology, Oncology and clinical Immunology, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany

    Guido Kobbe

  9. Dél-pesti Centrumkórház, Budapest, Hungary

    Péter Reményi

  10. Imperial College, London, United Kingdom

    Jane Apperley

  11. BMT Center “Louis Turcanu” Emergency Hospital for Children, Timisoara, Romania

    Arghirescu Smaranda

  12. CHU ESTAING, Clermont-Ferrand, France

    Jacques-Olivier Bay

  13. Klinikum Oldenburg, Oldenburg, Germany

    Jochen Casper

  14. Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

    Liesbeth C. de Wreede

  15. Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

    Sebastian Giebel

  16. ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, Milano, Italy

    Giovanni Grillo

  17. Hospital Morales Meseguer, Murcia, Spain

    Inmaculada Heras

  18. Kings College Hospital, London, United Kingdom

    Victoria Potter

  19. Klinikum Grosshadern, Munich, Germany

    Johanna Tischer

  20. Riga East University hospital, Riga, Latvia

    Ilze Trociukas

  21. University Hospital Innsbruck, Innsbruck, Austria

    David Nachbaur

  22. Central Clinical Hospital, The Medical University of Warsaw, Warsaw, Poland

    Joanna Drozd-Sokolowska

  23. University College London Hospitals NHS Trust, London, United Kingdom

    Kavita Raj & Donal McLornan

  24. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

    Carmelo Gurnari

  25. Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA

    Carmelo Gurnari

  26. CHRU Lille, Lille, France

    Ibrahim Yakoub-Agha

  27. Fondazione IRCCS - Ca’ Granda - Ospedale Maggiore Policlinico IRCCS, Milan, Italy

    Francesco Onida

  28. University of Cologne, Cologne, Germany

    Christof Scheid

Authors
  1. Marie Robin
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Contributions

MR wrote the paper, MR, DML, IYA designed the study, LG did the statistics, LCW reviewed the statistics, LK managed data, all authors discussed, validated the study and read the final version of the paper, RS, JF, EF, MR, GK, PR, JA, AS, JOB, JC, SG, GG, IH, VP, JT, IT, DN provided the patients.

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Correspondence to Marie Robin.

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Robin, M., Gras, L., Koster, L. et al. Are syngeneic donors a viable donor option in allogeneic haematopoietic cell transplantation for MDS? A brief report on behalf of the Chronic Malignancies Working Party of the EBMT and review of current literature. Bone Marrow Transplant 58, 942–945 (2023). https://doi.org/10.1038/s41409-023-01991-9

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