myelodysplastic syndrome MDS MDS MDS

Transcription

1 myelodysplastic syndrome MDS MDS MDS MDS MDS

2 2 3

3 4 MDS 1982 Bennett French- American-BritishFAB 1 2 WHO Vardiman MDS 5 2WHO FAB refractory anemiararefractory anemia with ringed sideroblastsrars RARARS refractory cytopenia with multilineage dysplasiarcmdrcmd with ringed sideroblasts 1French-American-BritishFAB FAB RA <1% <1,000 <5% - RARS <1% <1,000 <5% >15% RAEB <5% <1, % - RAEB in T >5% <1, % Auer CMML <5% >1,000 <20% - RA, refractory anemia; RARS, refractory anemia with ringed sideroblasts; RAEB, refractory anemia with excess of blasts; RAEB in T, refractory anemia with excess of blasts in transformation

4 2 WHO refractory anemiara RA with ringed sideroblasts RARS refractory cytopenia with multilineage dysplasiarcmd RCMD with ringed sideroblasts RCMD-RS <1% <1% <1% <1000/µl <1% <1000/µl RA with excess blastsraeb-1 <5% <15% <5% 15% 2 10% <5% <15% 2 10% <5% 15% 13 RAEB-2 MDS unclassified MDS associated with isolated del(5q) <5% <1000/µl 5% 20% / <1000/µl <1% <5% 5% 10% 13 10% 20% / <5% <5% 5

5 FAB 5% 20% refractory anemia with excess of blasts RAEB 20% 30% RAEB in transformationraeb in T WHO RAEB 5% 10% RAEB-110% 20% RAEB-2 20% WHO RAEB in T WHO MDS unclassified 5 5q- 5q- MDS WHO 6 MDS FAB WHO 6 International Prognostic Scoring System; IPSS 3 3 IPSS 20% RAEB in T WHO 3International Prognostic Scoring SystemIPSS Score value % < /1 2/3 -del(5q)del20q 7 3 <10g/dl; <1800/µl; <10 /µl 12000/µl Risk categories Score 60 low intermediate-1int intermediate-2int high MDS FAB RA RARSIPSS lowint-1

6 7 WHO RCMDRA 8 MDS MDS 9 K2 D3 G-CSF 1. MDS % 2. MDS MDS MDS MDS T MDS 1anti-thymocyte globulinatg MDS ATG 1997 Molldrem MDS ATG % % Killick % RARARS %RAEB % Stadler % RA %RAEB % Steensma 8 RAEB 8 6 RAEB ATG Jonásova RA 16 RAEB % 16 MDS MDS MDS % 1.76 IPSS 0.5 PNH paroxysmal nocturnal hematoglobinuria HLADR15 PNH PNH MDS 18 ATG quality of life

7 MDS 3. K2 D3 K2 D MDS RA K2 D3 D3 D3 19 K2 MDS MDS K2 K2 + D3 K2 16.7% 14% 21% K2 D3 33.3% MDS 22 granulocyte-colony stimulating factor MDS 23 70% MDS MDS 2005 MDS III MDS 43 2 g/dl 21 49% IPSS lowint % MDS 5 deletion 5qdel(5q) % % %del(5q) % del(5q) 25 del(5q) del(5q) del(5q) MDS % 8% 13% FAB RAEBRAEB in TWHO RAEB-1RAEB-2IPSS int-2high MDS MDS int-2 65 G-CSF 27

8 MDS MDS MDS/AML MDS Ara-C Japan Adult Leukemia Study Group JALSG 1993 Ara-C G-CSFAra-C 32% 56% JALSG MDS96 60 performance status 2 3 MDS 56 53% AML 8090% 5% 28 JALSG MDS96 Ara-C JALSG MDS JALSG MDS206G MDS Ara-C G-CSF G-CSF MDS G-CSF MDS 2834% 3454% MDS MDS % MDS 32 MDS MDS RARARS low highipss int-2high CD FAB HLA HLA HLA 5 RA %RAEB %RAEB in T % HSCT 39 MDS MDS MDS HLA Cutler lowint-1 IPSS int-2 high IPSS Nakai MDS

9 49% 26% 34% 48% 41 Nakai Ho refractory anemia 46 MDS 41% 20% 42 MDS EBMT 33 43% IBMTR % 40% HLA 29 40% 3750% 2348% 29,33,43 50% 44 MDS MDS 836 HLA % 33% 45% 41% 3 73% 28% 50 allo-hsct MDSsecondary AML %34% MDS 2000 MDS high risk % 48 1) :. 47: , ) Bennett JM, et al.: Proposals for the classification of the myelodysplastic syndrome. Br J Haematol 51: , ) Harris NL, et al.: World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues; report of the Clinical Advisory Committee meeting-artlie House, Virginia, November J Clin Oncol 17: , ) Brunning RD, et al.: Myelodysplastic syndromes. Jaffer ES, et al. (eds). World Health Organization Classification of Tumors. Pathology and Genetics, Tumor of Haematopoietic and Lymphoid Tissues, pp 61-73, IARC press, Lyon, ) Vardiman JW, et al.: The World Health Organization (WHO) classification of the myeloid neoplasms. Blood 100: , ) Greenberg P, et al.: International scoring system for evaluation prognosis in myelodysplastic

10 syndromes. Blood 89: , ), :. 47: 47-68, ) Nösslinger T, et al.: Myelodysplastic syndromes, from French-American-British to World Health Organization: comparison of classifications on 431 unselected patients from a single institution. Blood 98: , ) Sorror ML, et al.: Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106: , ) Cappellini MD, et al.: A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with thalassemia. Blood 107: , ) Molldrem JJ, et al.: Antithymocyte globulin for patients with myelodysplastic syndrome. Br J Haematol 99: , ) Molldrem JJ, et al.: Antithymocyte globulin for treatment of the bone marrow failure associated with myelodysplastic syndromes. Ann Intern Med 137: , ) Killick SB, et al.: A pilot study of antithymocyte globulin (ATG) in the treatment of patients with low-risk myelodysplasia. Br J Haematol 120: , ) Stadler M, et al.: A prospective, randomized, phase II study of horse antithymocyte globulin vs rabbit antithymocyte globulin as immunemodulating therapy in patients with low-risk myelodysplastic syndromes. Leukemia 18: , ) Steensma DP, et al.: Antithymocyte globulin has limited efficacy and substantial toxicity in unselected anemic patients with myelodysplastic syndrome. Blood 101: , ) Jonásova A, et al.: Cyclosporin A therapy in hypoplastic MDS patients and certain refractory anaemias without hypoplastic bone marrow. Br J Haematol 100: , ) Shimamoto T, et al.: Cyclosporin A therapy for patients with myelodysplastic syndrome: multicenter pilot studies in Japan. Leuk Res 27: , ) Ishiyama K, et al.: Polyclonal hematopoiesis maintained in patients with bone marrow failure harboring a minor population of paroxysmal nocturnal hemoglobinuria-type cells. Blood 102: , ) Funato K, et al.: Combination of 22-oxa-1, 25- dihydroxyvitamin D3, a vitamin D3 derivative, with vitamin K 2 (VK 2 ) synergistically enhances cell differentiation but suppresses VK 2 -inducing apoptosis in HL-60 cells. Leukemia 16: , ) Miyazawa K, et al.: Vitamin K2 therapy for myelodysplastic syndromes (MDS) and post- MNDS acute myeloid leukemia: information through a questionnaire survey of multi-center pilot studies in Japan. Leukemia 14: , ), : MDS K2+ D3. 16: , ) Hellström-Lindberg E: Efficacy of erythropoietin in the myelodysplastic syndromes: a meta-analysis of 205 patients from 17 studies. Br J Haematol 89: 67-71, ) Ozer H, et al.: 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol 18: , ) Hellström-Lindberg E, et al.: Treatment of anemia in myelodysplastic syndromes with granulocyte colony-stimulating factor plus erythropoietin: results from a randomized phase II study and long-term follow-up of 71 patients. Blood 92: 68-75, ) List A, et al.: Efficacy of Lenalidomide in myelodysplastic syndromes. N Eng J Med 352: , ) Kantarjian H, et al.: Decitabine improves patient outcomes in myelodysplastic syndromes-results of a phase III randomized study. Cancer 106: , ), :. 45: , ) Okamoto T, et al.: Combination chemotherapy with risk factor-adjusted dose attenuation for high-risk myelodysplastic syndrome and resulting leukemia in the Japan Adult Leukemia Study Group (JALSG): results of an interim analysis. Int J Hematol 72: , ) Anderson JE, et al.: Allogeneic bone marrow transplantation for 93 patients with myelodysplastic syndrome. Blood 82: , ) Castro-Malaspina H, et al.: Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood 99: , ) Zikos P, et al.: Low transplant mortality in allogeneic bone marrow transplantation for acute myeloid leukemia a randomized study of lowdose cyclosporine versus low-dose cyclosporine and low-dose methotrexate. Blood 91: , ) : 18. pp 33-41, ) de Witte T, et al.: Haematopoietic stem cell transplantation for patients with myelodysplastic syndromes and secondary acute myeloid

11 leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol 110: , ) Deeg HJ, Appelbaum FR: Hemopoietic stem cell transplantation for myelodysplastic syndrome. Curr Opin Oncol 12: , ) Sierra J, et al.: Bone marrow transplantation from HLA-identical siblings as treatment for myelodysplasia. Blood 100: , ) Appelbaum FR, Anderson J: Allogeneic bone marrow transplantation for myelodysplastic syndrome: outcomes analysis according to IPSS score. Leukemia 12 (Suppl. 1): S25-S29, ) Guardiola P, et al.: Retrospective comparison of bone marrow and granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells for allogeneic stem cell transplantation using HLA identical sibling donors in myelodysplastic syndromes. Blood 99: , ) Bittencourt H, et al.: Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA-identical sibling bone marrow transplantation. Blood 99: , ) 18. pp , ) Cutler CS, et al.: A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. Blood 104: , ) Nakai K, et al.: Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome. Leukemia 19: , ) Ho AY, et al.: Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulfan, and alemtuzumab (FBC) conditioning. Blood 104: , ) Longmore G, et al.: Bone marrow transplantation for myelodysplasia and secondary acute nonlymphoblastic leukemia. J Clin Oncol 8: , ) Arnold R, et al.: Unrelated bone marrow transplantation in patients with myelodysplastic syndromes and secondary acute myeloid leukemia: an EBMT survey. European Blood and Marrow Transplantation Group. Bone Marrow Transplant 21: , ) Estey E, et al.: Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Blood 109: , ) Martino R, et al.: Retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic hematopoietic stem cell transplantation using HLA-identical sibling donors in myelodysplastic syndromes. Blood 108: , ) Kröger N, et al.: Reduced-intensity conditioning with treosulfan, fludarabine and ATG as preparative regimen for allogeneic stem cell transplantation (allosct) in elderly patients with secondary acute myeloid leukemia (saml) or myelodysplastic syndrome (MDS). Bone Marrow Transplant 37: , ) Ooi J, et al.: Unrelated cord blood transplantation for adult patients with advanced myelodysplastic syndrome. Blood 101: , 2003