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Blood, 1 January 2008, Vol. 111, No. 1, pp. 94-100.
Prepublished online as a Blood First Edition Paper on September 25, 2007; DOI 10.1182/blood-2007-06-097444.
 Previous Article | Next Article 
Submitted June 22, 2007
Accepted September 10, 2007
Cytogenetically defined myelodysplasia after melphalan-based autotranplants for multiple myeloma linked to poor hematopoietic stem cell mobilization: the Arkansas experience in more than 3000 patients treated since 1989
Bart Barlogie*, Guido Tricot, Jeff Haessler, Frits van Rhee, Michele Cottler-Fox, Elias Anaissie, James Waldron, Mauricio Pineda-Roman, Raymond Thertulien, Maurizio Zangari, Klaus Hollmig, Abid Mohiuddin, Yazan Alsayed, Antje Hoering, John Crowley, and Jeffrey Sawyer
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR
Cancer Research and Biostatistics, Seattle, WA
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
* Corresponding author; email: barlogiebart{at}uams.edu.
Myelodysplasia (MDS) is a well recognized complication of chemotherapy for multiple myeloma (MM). Serial bone marrow metaphase examinations were performed for MM re-staging in 3077 patients undergoing high-dose therapy (HDT). MDS-associated cytogenetic abnormalities (MDS-CA) were observed in 105 of 2418 patients in whom cytogenetic data were available post-HDT. MDS-CA occurred transiently in 72 and on 3 successive occasions (persistent MDS-CA) in 33 patients, for 10-yr estimates of 4% and 2%; only 21 patients developed overt clinical MDS and 5 AML. MDS-CA development was linked to lower CD34 yield at collection, longer time interval from MM diagnosis to HDT, older age and lower platelet recovery post-HDT; persistent MDS-CA was predicted by CD34 yield <3x106/kg and need for more than 2 apheresis procedures. Applying a tertile frequency distribution over time to all 105 patients with MDS-CA, its detection early post-HDT was associated with longer time interval from diagnosis and low pre-HDT platelet count (likely resulting from pre-HDT damage), whereas late-onset MDS-CA was noted among patients treated with Total Therapy 2 and Total Therapy 3 that applied post-HDT consolidation chemotherapy (suggesting possible post-HDT damage). While the risk of MDS-CA was low and clinical MDS occurred infrequently, monitoring after post-HDT consolidation chemotherapy appears warranted.
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