INCIDENCE AND CHARACTERIZATION OF SECONDARY MYELODYSPLASTIC SYNDROME AND ACUTE MYELOGENOUS LEUKEMIA FOLLOWING HIGH-DOSE CHEMORADIOTHERAPY AND AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR LYMPHOID MALIGNANCIES

Purpose: To analyze the risk of developing myelodysplastic syndrome (M DS) or acute myelogenous leukemia (AML) following autologous bone marr ow transplantation (ABMT) or peripheral stem-cell transplantation (PSC T) and to determine the impact on failure-free survival (FFS). Patient s and Methods: patients underwent ABMT or PSCT for the treatment of Ho dgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) at the Universit y of Nebraska Medical Center. For those patients who went on to develo p MDS/AML, controls were selected and a case-control-within-a-cohort s tudy undertaken. Results: Twelve patients developed MDS or AML a media n of 44 months following ABMT/PSCT. The cumulative incidence (P =.42) and the conditional probability (P =.32) of MDS/AML were not statistic ally different between HD and NHL patients. Age greater than 40 years at the time of transplant (P =.05) and receipt of a total-body irradia tion (TBI)-containing regimen (P =.06) were predictive for developing MDS/AML in patients with NHL. Conclusion: There is an increased risk o f MDS/AML following AMBT/PSCT for lymphoid malignancies. NHL patients age greater than or equal to 40 years at the time of transplant and wh o received TBI are at greatest risk. (C) 1994 by American Society of C linical Oncology.