Bone marrow transplantation for therapy-related myelodysplasia: comparison with primary myelodysplasia

Therapy-related myelodysplasia (MDS) is a fatal marrow disorder distinct from primary MDS. We examined the efficacy of bone marrow transplantation (BMT) as a treatment for patients with therapy-related MDS, Eighteen patients with therapy-related MDS and twenty-five patients with primary MDS received an allogeneic, syngeneic, or unrelated donor BMT, Graft-versus-host disease prophylaxis included methotrexate, plus cyclosporine, FK-506, or T cell depletion. Conditioning regimens consisted of cyclophosphamide/total body irradiation, with and without cytosine arabinoside, busulfan/cyclophosphamide, and cyclophosphamide/etoposide/carmustine. For patients with therapy-related MDS, the median age was 32 years and the actuarial disease-free survival was 24% (95% confidence interval 6, 42%) with a median follow-up of 3 years, For patients with primary MDS, the median age was 36 years and the actuarial disease-free survival at 3 years was 43% (95% confidence interval 22, 64%), Four of the therapy-related patients and two of the primary patients have relapsed, Three patients experienced graft failure; all three had received T cell-depleted marrow and two had marrow fibrosis, Our results suggest that patients with therapy-related MDS can be successfully transplanted, Transplantation should be considered early in the disease, since longterm disease-free survival is achievable.