Low incidence of myelodysplasia or acute leukemia after autologous blood and marrow transplant without total body radiation for lymphoma

We evaluated the incidence of myelodysplastic syndrome and acute myeloid leukemia (MDS/AML) in long term survivors following high dose chemotherapy and autologous blood and marrow transplantation (ABMT) for relapsed or refractory Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL), using a regimen that does not employ total body irradiation (TBI). From 12/1986 to 12/1995, 309 patients (pts) (148 HD, 156 NHL, 5 discordant lymphoma) received etoposide 60 mg/kg + melphalan 160 -180 mg/m² supported by autologous bone marrow or blood cells including 51 pts with low or high grade NHL who also received TBI 2 Gy twice daily × 6 fractions. 139β09 pts (45 %) are continuously disease free (DF) > I year post ABMT (median follow-up 45 months, range 12-120). Seven pts have developed MDS (5 pts) or AML (2 pts) after ABMT, six were free of lymphoma at diagnosis of secondary leukemia and one pt developed MDS following radiation for local relapse. None of the pts who developed MDS/AML had received TBI. The crude rate of MDS/AML at 5 years post-ABMT in the overall group is 2.3 % (95% C I; 1.1- 4.6%). Actuarial probability of a clonal bone marrow disorder in pts who remain DF is 7 % (± 3 %SE) at 4 years. Of the 4 pts with MDS/AML who had marrow cytogenetics performed, 2 had monosomy 7, one had 1 Iql3 and one pt had Hq23 rearrangement in addition to trisomy 8. All also had other chromosomal abnormalities. Studies are in progress using interphase fluorescence in-situ hybridization (FISH) to detect karyotypic abnormalities earlier in the post-transplant cohort. Compared to previous reports, MDS/AML is less common after ABMT with etoposide + melphalan in pts with lymphoma, but can arise in pts who do not receive TBI.