Machiko Fujioka, Hidehiro Itonaga, Yasushi Miyazaki, Yoshimitsu Shimomura, Shigesaburo Miyakoshi, Shinichiro Machida, Naoyuki Uchida, Takeshi Maeda, Masatsugu Tanaka, Yasufumi Uehara, Satoshi Takahashi, Noriko Doki, Naoyuki Anzai, Mamiko Sakata-Yanagimoto, Toshimitsu Ueki, Masashi Sawa, Yoshiko Matsuhashi, Yuta Katayama, Fumihiko Ishimaru, Makoto Onizuka, Junya Kanda, Yoshiko Atsuta, Ken Ishiyama, adult MDS working group of the Japanese Society for Transplantation and Cellular Therapy
Cord blood transplantation (CBT) is an alternative donor strategy for patients with myelodysplastic syndrome (MDS). To clarify the impact of the Transplant Conditioning Intensity (TCI) score, we examined 1127 patients with de novo MDS who underwent CBT between 2008 and 2022, using a nationwide registry database. Patients were stratified into three age groups: <50 years (Younger group, n=256), 50-64 years (Middle group, n=545), and 65-74 years (Older group, n=326). In the Older group, the multivariate analysis revealed that TCI score of 4.5-5.0 correlated with higher overall mortality than TCI score of 3.5-4.0 (HR 1.61, 95% CI 1.02-2.49, p=0.032). In the Middle group, TCI score of 4.5-5.0 was associated with lower relapse incidence than TCI score of 3.5-4.0 (HR 0.64, 95% CI 0.45-0.91, p=0.014), but did not have any significant impact on overall mortality. In the Younger group, no significant difference was observed in overall mortality, relapse incidence, and non-relapse mortality. Collectively, these findings support the utility of TCI score-based conditioning stratification as a practical framework for guiding age-adapted conditioning regimen selection in patients with de novo MDS undergoing CBT.