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

R. Howe, Ivana Micallef, D. J. Inwards, Stephen Maxted Ansell, G. W. Dewald, Angela Dispenzieri, D. A. Gastineau, Morie Gertz, S. M. Geyer, C. A. Hanson, Martha Lacy, Ayalew Tefferi, Mark R Litzow

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)317-324
Number of pages8
JournalBone Marrow Transplantation
Volume32
Issue number3
DOIs
StatePublished - Aug 2003

Fingerprint

Myelodysplastic Syndromes
Stem Cell Transplantation
Acute Myeloid Leukemia
Lymphoma
Incidence
Fluorescence In Situ Hybridization
Mechlorethamine
Chromosomes, Human, Pair 5
Alkylating Agents
Hodgkin Disease
Karyotype
Non-Hodgkin's Lymphoma
Cyclophosphamide
Bone Marrow

Keywords

  • Autologous stem cell transplantation
  • Lymphoma
  • Secondary MDS

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

@article{bed04c33622f4d7cbadb0e96786b2950,
title = "Secondary myelodysplastic syndrome and acute myelogenous leukemia are significant complications following autologous stem cell transplantation for lymphoma",
abstract = "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.",
keywords = "Autologous stem cell transplantation, Lymphoma, Secondary MDS",
author = "R. Howe and Ivana Micallef and Inwards, {D. J.} and Ansell, {Stephen Maxted} and Dewald, {G. W.} and Angela Dispenzieri and Gastineau, {D. A.} and Morie Gertz and Geyer, {S. M.} and Hanson, {C. A.} and Martha Lacy and Ayalew Tefferi and Litzow, {Mark R}",
year = "2003",
month = "8",
doi = "10.1038/sj.bmt.1704124",
language = "English (US)",
volume = "32",
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T1 - Secondary myelodysplastic syndrome and acute myelogenous leukemia are significant complications following autologous stem cell transplantation for lymphoma

AU - Howe, R.

AU - Micallef, Ivana

AU - Inwards, D. J.

AU - Ansell, Stephen Maxted

AU - Dewald, G. W.

AU - Dispenzieri, Angela

AU - Gastineau, D. A.

AU - Gertz, Morie

AU - Geyer, S. M.

AU - Hanson, C. A.

AU - Lacy, Martha

AU - Tefferi, Ayalew

AU - Litzow, Mark R

PY - 2003/8

Y1 - 2003/8

N2 - 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.

AB - 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.

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