Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell transplantation

• Published in: Haematologica (Roma) Vol. 94; no. 4; pp. 542 - 549
• Main Authors: Kroger, Nicolaus, Brand, Ronald, van Biezen, Anja, Zander, Axel, Dierlamm, Judith, Niederwieser, Dietger, Devergie, Agnes, Ruutu, Tapani, Cornish, Jackie, Ljungman, Per, Gratwohl, Alois, Cordonnier, Catherine, Beelen, Dietrich, Deconinck, Eric, Symeonidis, Argiris, de Witte, Theo, Myelodysplastic Syndromes Subcommittee of The Chronic Leukaemia Working Party of European Group for Blood and Marrow Transplantation (EBMT)
• Format: Journal Article
• Language: English
• Published: Pavia Ferrata Storti Foundation 01.04.2009
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Child; Child, Preschool; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cell Transplantation - mortality; Humans; Immunology; Leukemia, Myeloid, Acute; Leukemia, Myeloid, Acute - chemically induced; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Life Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Myelodysplastic Syndromes; Myelodysplastic Syndromes - chemically induced; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; Neoplasms, Second Primary; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - mortality; Neoplasms, Second Primary - therapy; Original; Prognosis; Retrospective Studies; Risk Factors; Transplantation, Homologous; Treatment Outcome; Young Adult; Acute myelogenous leukemia; Hematology; Stem cell; cytogenetic abnormalities; Hematopoietic cell; Homograft; Malignant hemopathy; Epidemiology; Myelodysplastic syndrome; therapy-related; Treatment; allogeneic stem cell transplantation; Risk factor; Cytogenetics; Graft; Cancer; acute myelogenous leukemia; myelodysplastic syndrome
• ISSN: 0390-6078; 1592-8721; 1592-8721
• DOI: 10.3324/haematol.2008.000927

1 Dept. for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Germany 2 Dept. of Medical Statistics, Leiden University, Leiden, The Netherlands 3 Dept. of Haematology and Oncology, University Hospital Hamburg-Eppendorf, Germany 4 Dept. of Haematology and Oncology, University of Leipzig, Germany 5 Dept. of Hematology, BMT, Hôpital St. Louis, Paris, France 6 Dept. of Medicine, Helsinki University Central Hospital, Helsinki, Finland 7 Dept. of Paediatric Oncology/BMT, Bristol Royal Hospital for Children, Bristol, United Kingdom 8 Dept. of Hematology, Huddinge University Hospital, Huddinge, Sweden 9 Dept. of Hematology, University Hospital, Basel, Switzerland 10 Dept. of Hematology, Henri Mondor Teaching Hospital, Creteil, France 11 Dept. of Bone Marrow Transplantation, University Hospital, Essen, Germany 12 Dept. of Hematology, Hôpital Jean Minjoz, Besancon, France 13 Dept of Hematology, University of Patras, Patras, Greece 14 Dept. of Hematology, University Medical Center St. Radboud, Nijmegen, The Netherlands Correspondence: Nicolaus Kröger, Dept. for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. E-mail: nkroeger{at}uke.uni-hamburg.de Background: After successful treatment of malignant diseases, therapy-related myelodysplastic syndrome and acute myeloid leukemia have emerged as significant problems. Design and Methods: The aim of this study was to investigate outcome and risk factors in patients with therapy-related myelodysplastic syndrome or acute myeloid leukemia who underwent allogeneic stem cell transplantation. Between 1981 and 2006, 461 patients with therapy-related myelodysplastic syndrome or acute myeloid, a median age of 40 years and a history of solid tumor (n=163), malignant lymphoma (n=133), or other hematologic diseases (n=57) underwent stem cell transplantation and their data were reported to the European Group for Blood and Marrow Transplantation. Results: The cumulative incidence of non-relapse mortality and relapse at 3 years was 37% and 31%, respectively. In a multivariate analysis significant factors for relapse were not being in complete remission at the time of transplantation ( p =0.002), abnormal cytogenetics ( p =0.005), higher patients’ age ( p =0.03) and therapy-related myelodysplastic syndrome ( p =0.04), while higher non-relapse mortality was influenced by higher patients’ age. Furthermore, there was a marked reduction in non-relapse mortality per calendar year during the study period ( p <0.001). The 3-year relapse-free and overall survival rates were 33% and 35%, respectively. In a multivariate analysis significant higher overall survival rates were seen per calendar year ( p <0.001), for younger age (<40 years) and normal cytogenetics ( p =0.05). Using age (<40 years), abnormal cytogenetics and not being in complete remission at the time of transplantation as risk factors, three different risk groups with overall survival rates of 62%, 33% and 24% could be easily distinguished. Conclusions: Allogeneic stem cell transplantation can cure patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia and has markedly improved over time. Non-complete remission, abnormal cytogenetics and higher patients’ age are the most significant factors predicting survival. Key words: allogeneic stem cell transplantation, therapy-related, myelodysplastic syndrome, acute myelogenous leukemia, cytogenetic abnormalities. Related Article Therapy-related myeloid neoplasms Richard A. Larson Haematologica 2009 94: 454-459. [Full Text] [PDF]