BONE-MARROW TRANSPLANTATION FOR THERAPY-RELATED MYELODYSPLASIA - COMPARISON WITH PRIMARY MYELODYSPLASIA

Therapy-related myelodysplasia (MDS) is a fatal marrow disorder distin ct from primary MDS. We examined the efficacy of bone marrow transplan tation (BMT) as a treatment for patients with therapy-related MDS, Eig hteen patients with therapy-related MDS and twenty-five patients with primary MDS received an allogeneic, syngeneic, or unrelated donor BMT, Graft-versus-host disease prophylaxis included methotrexate, plus cyc losporine, FK-506, or T cell depletion. Conditioning regimens consiste d of cyclophosphamide/total body irradiation, with and without cytosin e arabinoside, busulfan/cyclophosphamide, and cyclophosphamide/etoposi de/carmustine. For patients with therapy-related MDS, the median age w as 32 years and the actuarial disease-free survival was 24% (95% confi dence interval 6, 42%) with a median follow-up of 3 years, For patient s with primary MDS, the median age was 36 years and the actuarial dise ase-free survival at 3 years was 43% (95% confidence interval 22, 64%) , Four of the therapy-related patients and two of the primary patients have relapsed, Three patients experienced graft failure; all three ha d received T cell-depleted marrow and two had marrow fibrosis, Our res ults suggest that patients with therapy-related MDS can be successfull y transplanted, Transplantation should be considered early in the dise ase, since longterm disease-free survival is achievable.