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Prepublished online as a Blood First Edition Paper on October 10, 2002; DOI 10.1182/blood-2002-04-1261.

Submitted April 29, 2002
Accepted September 20, 2002
Myelodysplastic syndrome and acute myeloid leukemia after autotransplantation for lymphoma: a multicenter case-control study
Catherine Metayer, Rochelle E Curtis*, Julie Vose, Kathleen A Sobocinski, Mary M Horowitz, Smita Bhatia, Joseph W Fay, Cesar O Freytes, Steven C Goldstein, Roger H Herzig, Armand Keating, Carol B Miller, Thomas J Nevill, Andrew L Pecora, J D Rizzo, Stephanie F Williams, Chin-Yang Li, Lois B Travis, and Daniel J Weisdorf
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
University of Nebraska Medical Center, Omaha, NE, USA
Autologous Blood and Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee, WI, USA
City of Hope National Medical Center, Duarte, CA, USA
Baylor University Medical Center, Dallas, TX, USA
University of Texas, Health Science Center, San Antonio, TX, USA
H. Lee Moffitt Cancer Center, Tampa, FL, USA
University of Louisville Hospital, Louisville, KE, USA
the Princess Margaret Hospital/Ontario Cancer Institute, Toronto, ON, Canada
Johns Hopkins Oncology Center, Baltimore, MD, USA
British Columbia Cancer Agency and Vancouver General Hospital, Vancouver, BC, Canada
the Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
University of Chicago Medical Center, Chicago, IL, USA
Mayo Clinic, Rochester, MN, USA
University of Minnesota Medical School, Minneapolis, MN, USA
* Corresponding author; email: curtisr{at}epndce.nci.nih.gov.
Although numerous reports indicate that patients receiving autotransplants for lymphoma are at increased risk for myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML), the separate contributions of pre-transplant and transplant-related therapy are not well characterized. We conducted a case-control study of 56 patients with MDS/AML and 168 matched controls within a cohort of 2,739 patients receiving autotransplants for Hodgkin disease or non-Hodgkin lymphoma at 12 institutions (1989-1995). Detailed abstraction of medical records was undertaken to determine all pre- and post-transplant therapy, and transplant-related procedures. In multivariate analyses, risks of MDS/AML significantly increased with the intensity of pre-transplant chemotherapy including mechlorethamine (relative risks [RR] = 2.0 and 4.3 for cumulative doses < 50 mg/m2 and 50 mg/m2, respectively, P trend = 0.04) or chlorambucil (RRs = 3.8 and 8.4 for duration <10 months or 10 months, respectively, P trend = 0.009), compared with cyclophosphamide-based therapy. Transplant conditioning regimens including total-body irradiation (TBI) at doses 12 Gy did not appear to elevate leukemia risk (RR = 1.4, P = 0.46) compared with non-TBI regimens; however, a statistically significant increased risk was found for TBI doses of 13.2 Gy (RR = 4.7, P = 0.03). Peripheral blood stem cells were associated with a non-significant increased risk of MDS/AML (RR = 1.8, P = 0.12) compared with bone marrow grafts. Our data show that type and intensity of pre-transplant chemotherapy with alkylating agents are important risk factors of MDS/AML following autotransplantation. Transplant-related factors may also modulate this risk; however, the apparent contribution of high-dose TBI requires confirmation.

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