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Blood, Vol. 95 No. 5 (March 1), 2000:
pp. 1588-1593
Predictors of therapy-related leukemia and myelodysplasia
following autologous transplantation for lymphoma: an assessment of
risk factors
Amrita Krishnan,
Smita Bhatia,
Marilyn L. Slovak,
Daniel A. Arber,
Joyce C. Niland,
Auayporn Nademanee,
Henry Fung,
Ravi Bhatia,
Ashwin Kashyap,
Arturo Molina,
Margaret R. O'Donnell,
Pablo A. Parker,
Irena Sniecinski,
David S. Snyder,
Ricardo Spielberger,
Anthony Stein, and
Stephen J. Forman
Divisions of Hematology and Bone Marrow Transplantation,
Pediatric Oncology, Biostatistics and Pathology, City of Hope
National Medical Center, Duarte, CA.
We analyzed data on 612 patients who had undergone high-dose
chemoradiotherapy (HDT) with autologous stem cell rescue for Hodgkin's
disease (HD) and non-Hodgkin's lymphoma (NHL) at the City of Hope
National Medical Center, to evaluate the incidence of therapy-related
myelodysplasia (t-MDS) or therapy-related acute myeloid leukemia
(t-AML) and associated risk factors. A retrospective cohort and a
nested case-control study design were used to evaluate the role of
pretransplant therapeutic exposures and transplant conditioning
regimens. Twenty-two patients developed morphologic evidence of
t-MDS/t-AML. The estimated cumulative probability of developing
morphologic t-MDS/t-AML was 8.6% ± 2.1% at 6 years. Multivariate
analysis of the entire cohort revealed stem cell priming with VP-16
(RR = 7.7, P = 0.002) to be independently associated with an increased risk of t-MDS/t-AML. The influence of pretransplant therapy on subsequent t-MDS/t-AML risk was determined by a case-control study. Multivariate analysis revealed an association between
pretransplant radiation and the risk of t-MDS/t-AML, but failed to
reveal any association with pretransplant chemotherapy or conditioning
regimens. However, patients who had been primed with VP-16 for stem
cell mobilization were at a 12.3-fold increased risk of developing t-AML with 11q23/21q22 abnormalities (P = 0.006). Patients
undergoing HDT with stem cell rescue are at an increased risk of
t-MDS/t-AML, especially those receiving priming with VP-16 for
peripheral stem cell collection.

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