Secondary myelodysplastic syndrome and acute myelogenous leukemia are significant complications following autologous stem cell transplantation for lymphoma

被引:43
作者
Howe, R
Micallef, INM
Inwards, DJ
Ansell, SM
Dewald, GW
Dispenzieri, A
Gastineau, DA
Gertz, MA
Geyer, SM
Hanson, CA
Lacy, MQ
Tefferi, A
Litzow, MR
机构
[1] Mayo Clin, Div Hematol, Rochester, MN 55905 USA
[2] Mayo Clin, Dept Internal Med, Rochester, MN 55905 USA
[3] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN 55905 USA
[4] Mayo Clin, Dept Biostat, Rochester, MN 55905 USA
关键词
secondary MDS; autologous stem cell transplantation; lymphoma;
D O I
10.1038/sj.bmt.1704124
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Secondary myelodysplastic syndrome (sMDS) and acute myelogenous leukemia (AML) have been recognized with increasing frequency following autologous stem cell transplantation ( ASCT). A retrospective analysis of 230 consecutive patients with Hodgkin's lymphoma (HL, 64) and non-Hodgkin's lymphoma (NHL, 166) who underwent ASCT was conducted to assess the incidence and risk factors for the development of sMDS/AML. At a median follow up of 41 months ( range 0.1 - 177 months), 10 of 230 patients (4.3%) developed sMDS/AML. The 5-year-actuarial incidence of sMDS/AML was 13.1% and 5-year cumulative incidence by competing risk analysis was 4.2%. The median time to development of sMDS/AML was 39.9 months from the time of ASCT ( range 12.1 - 62.0 months). Complex karyotypes at diagnosis of sMDS/ AML included structural anomalies and/or loss of chromosome 5 ( eight patients), 7 (five patients), 17 ( two patients) and 20 ( two patients). All patients subsequently died, at a median of 6.8 months ( range 0 - 39.9) from diagnosis of sMDS/ AML. Fluorescent in situ hybridization ( FISH) analysis for - 5/ 5q- and - 7/ 7q- were normal in all six patients whose pre-ASCT bone marrow was available for testing. Five of the six had samples available for testing at diagnosis of sMDS/ AML and all had abnormal FISH results. By univariate statistical analysis, male gender ( P = 0.01), prior alkylating agents ( mechlorethamine for HL, P = 0.001 and cyclophosphamide for NHL, P = 0.05) and the number of prior treatment regimens ( P = 0.04) were significantly associated with the development of sMDS/ AML. Given the relatively low incidence rate of sMDS/ AML, these analyses are primarily exploratory in nature but provide some insight into relevant risk factors and illustrate the risk of developing sMDS/AML after myeloablative conditioning and ASCT for lymphoma.
引用
收藏
页码:317 / 324
页数:8
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