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Myelodysplastic syndrome after autologous bone marrow transplantation: an
additional late complication of curative cancer therapy [see comments]
JS Miller, DC Arthur, CE Litz, JP Neglia, WJ Miller and DJ Weisdorf
Department of Medicine, University of Minnesota Medical School,
Minneapolis.
Myelodysplastic syndrome (MDS) is a complication of conventional
antineoplastic therapy but has rarely been reported after autologous bone
marrow transplantation (ABMT). We reviewed records of 206 patients who
underwent ABMT for lymphoma at the University of Minnesota (Minneapolis,
MN) between 1974 and 1993. Of 206 patients who underwent ABMT for
non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD), 9 patients
developed an MDS or secondary acute leukemia between 5 and 60 months
(median 34 months) post-BMT. Two patients had relapsed after transplant and
received additional therapy before the diagnosis of MDS. They were censored
from the statistical analysis, resulting in a cumulative incidence of 14.5%
+/- 11.6% (95% confidence interval) at 5 years. Three patients (15.2% +/-
18.0%) had HD, and four (14.0% +/- 14.7%) had NHL. In vitro BM purging had
no affect on the incidence of MDS, although patients receiving peripheral
blood stem cells had a projected MDS incidence of 31% +/- 33% versus 10.5%
+/- 12% if BM cells were used (p = .0035). The patients had received a
median of 14 cycles (range, 6 to 40) of chemotherapy before autologous
transplantation; Five of nine patients received radiation therapy before
BMT conditioning, and all patients received radiation before the diagnosis
of MDS. No BM cytogenetic abnormalities were evident pretransplant in three
of three patients studied, and all nine had normal pretransplant BM
morphology. All patients had morphologic BM findings typical of MDS, and
six of six studied had clonal cytogenetic abnormalities. At the diagnosis
of MDS, all nine patients were without clinical, radiographic, or autopsy
evidence of recurrent lymphoma; Three of the nine patients have died from
complications of cytopenias at 23, 36, and 45 months after transplant (3 to
10 months after the diagnosis of MDS), whereas 6 survive 8 to 63 months
after transplantation (1 to 34 months post-MDS). These data emphasize the
cumulative leukemogenic potential of standard and salvage radiation and
chemotherapy regimens and highlight treatment-induced MDS as an important
and frequent late complication of potentially curative BM transplant
therapy.
Volume 83,
Issue 12,
pp. 3780-3786,
06/15/1994
Copyright © 1994 by The American Society of Hematology
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