Donor change linked to lower relapse risk after second allogeneic transplant for MDS

An observational study published in Blood evaluated outcomes and risk factors in 313 adults undergoing a second allogeneic stem cell transplantation for relapsed myelodysplastic neoplasms between 2012 and 2023. The analysis focused on donor change, reported in 71% of patients. Second-transplant donors were matched related, matched unrelated or haploidentical in 19%, 62% and 19%, respectively.

At two years, overall survival was 45%, progression-free survival 33%, cumulative relapse incidence 37% and non-relapse mortality 30%. Overall and progression-free survival reached 51% and 39%, respectively, among patients transplanted in 2018–2023. In multivariable analyses, donor change was associated with lower relapse risk (hazard ratio 0.56; 95% CI 0.36–0.89), whereas adverse cytogenetics were associated with higher risk (hazard ratio 1.93; 95% CI 1.18–3.17).

Remission lasting at least 12 months after the first transplant and a Karnofsky performance score of at least 90 at the second transplant were associated with better overall and progression-free survival. Non-relapse mortality decreased in more recent transplant years and was lower with better performance status. These findings may inform donor selection, but the observational design cannot establish causality. A trend toward increased non-relapse mortality with donor change precluded a significant survival benefit. Only the abstract was available for assessment.