Journal: British journal of haematology
This nationwide retrospective study analyzed 7,175 patients with MDS or MDS/MPN who underwent first allogeneic HSCT between 1998 and 2022, focusing on changes in outcomes over time.
Key findings:
- Overall survival has improved meaningfully over the past two decades for:
- Early MDS
- Advanced MDS
- Chronic myelomonocytic leukaemia (CMML)
- Atypical CML
- The hazard of death declined in these groups in more recent transplant eras (2013–2017 and 2018–2022) compared with earlier years, with statistically significant reductions in overall mortality.
- The main driver of improved survival was reduced non-relapse mortality, implying advances in transplant technique, supportive care, donor selection, conditioning, or GVHD management rather than improved disease control.
- In contrast, there was no significant survival improvement over time for:
- MDS/MPN-unclassifiable
- Therapy-related myeloid neoplasms
- Relapse incidence did not significantly change over time across all disease subtypes, underscoring that post-transplant relapse remains a key unresolved problem despite better transplant safety.