INCIDENCE AND CHARACTERIZATION OF SECONDARY MYELODYSPLASTIC SYNDROME AND ACUTE MYELOGENOUS LEUKEMIA FOLLOWING HIGH-DOSE CHEMORADIOTHERAPY AND AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR LYMPHOID MALIGNANCIES

Purpose: To analyze the risk of developing myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML) following autologous bone marrow transplantation (ABMT) or peripheral stem-cell transplantation (PSCT) and to determine the impact on failure-free survival (FFS). Patients and Methods: patients underwent ABMT or PSCT for the treatment of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) at the University of Nebraska Medical Center. For those patients who went on to develop MDS/AML, controls were selected and a case-control-within-a-cohort study undertaken. Results: Twelve patients developed MDS or AML a median of 44 months following ABMT/PSCT. The cumulative incidence (P =.42) and the conditional probability (P =.32) of MDS/AML were not statistically different between HD and NHL patients. Age greater than 40 years at the time of transplant (P =.05) and receipt of a total-body irradiation (TBI)-containing regimen (P =.06) were predictive for developing MDS/AML in patients with NHL. Conclusion: There is an increased risk of MDS/AML following AMBT/PSCT for lymphoid malignancies. NHL patients age greater than or equal to 40 years at the time of transplant and who received TBI are at greatest risk. (C) 1994 by American Society of Clinical Oncology.