# BMT CTN 1102: biologic assignment trial of reduced-intensity transplant by donor availability in patients aged 50 to 75 with advanced myelodysplastic syndrome

Source: https://onco.cc/key-papers/paper-bmt-ctn-1102-transplant-older-mds-nakamura-jco-2021/  
OnCo record `paper-bmt-ctn-1102-transplant-older-mds-nakamura-jco-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Older people with higher-risk myelodysplastic syndrome who had a matched donor and went on to a reduced-intensity stem-cell transplant were much more likely to be alive three years later than those without a donor treated with drugs, which makes transplant part of standard planning for fit patients up to 75.

## Summary

Multicentre biologic assignment trial of the Blood and Marrow Transplant Clinical Trials Network: 384 patients aged 50 to 75 with intermediate-2 or high-risk de novo myelodysplastic syndrome enrolled at 34 centres between 2014 and 2018 were assigned to the donor arm (reduced-intensity allogeneic transplant) or the no-donor arm (hypomethylating therapy or best supportive care) according to whether a matched donor was identified within 90 days.

In the intention-to-treat analysis, adjusted three-year overall survival was 47.9 percent in the donor arm against 26.6 percent in the no-donor arm (absolute difference 21.3 percentage points), and leukaemia-free survival 35.8 against 20.6 percent. The benefit was seen across all subgroups examined.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: Journal of Clinical Oncology
- Year: 2021
- DOI: 10.1200/JCO.20.03380
- Authors: Nakamura R, Saber W, Martens MJ, et al.
- Findings: Adjusted three-year overall survival 47.9 percent (95% CI 41.3 to 54.1) with a donor versus 26.6 percent (18.4 to 35.6) without (p 0.0001).; Three-year leukaemia-free survival 35.8 versus 20.6 percent (p 0.003).; Survival benefit consistent across all subgroups.
- What it means: Allogeneic transplant should be included in the management plan of fit older adults with higher-risk myelodysplastic syndrome; donor search should start at diagnosis.
- Caveats: Assignment by donor availability rather than randomisation; not every donor-arm patient was transplanted and the analysis is by intention to treat.; Reduced-intensity conditioning only.

## Sources

- J Clin Oncol 2021: https://doi.org/10.1200/JCO.20.03380
- PubMed: https://pubmed.ncbi.nlm.nih.gov/34106753/

## Connected records

- cancers: [Higher-risk myelodysplastic syndromes](https://onco.cc/cancers/mds-higher-risk/), [Myelodysplastic syndromes / neoplasms (MDS)](https://onco.cc/cancers/mds/)
- trials: [BMT CTN 1102](https://onco.cc/trials/bmt-ctn-1102/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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