MYELODYSPLASTIC SYNDROME AS A LATE COMPLICATION FOLLOWING AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMA

Purpose: To determine the incidence, natural history, and risk factors associated with myelodysplastic syndrome (MDS) occurring as a late co mplication following autologous bone marrow transplantation for patien ts with non-Hodgkin's lymphoma. Methods: We retrospectively reviewed t he charts of all 262 patients who underwent autologous bone marrow tra nsplantation for non-Hodgkin's lymphoma at the Dana-Farber Cancer Inst itute from 1982 through 1991. Although patients received a variety of treatments before they were eligible for transplant, identical myeloab lative therapy (cyclophosphamide 60 mg/kg/d for 2 days plus total-body irradiation twice daily for 3 days) was administered in each case. By collecting data on pretransplant and early posttransplant variables, we attempted to identify risk factors for the development of MDS. Resu lts: The crude overall incidence of posttransplant MDS or acute myeloi d leukemia (AML) was 7.6%. The actuarial risk at 6 years was 18% +/- 9 %. The median time of onset was 31 months (range, 10 to 101) after tra nsplant or 69 months (range, 27 to 141) after initial treatment for ly mphoma. Pretreatment variables predictive for the development of MDS ( univariate analysis) included prolonged interval between initial treat ment and the transplant procedure (P =.003), increased duration of exp osure to chemotherapy (P =.019) or to alkylating agents (P =.045), and use of radiation therapy (P =.032) or pelvic radiation (P =.003) befo re transplant. Conclusion: MDS is a potential complication of autologo us bone marrow transplantation for non-Hodgkin's lymphoma; bone marrow stem-cell damage sustained before the transplant may be the most impo rtant risk factor. (C) 1994 by American Society of Clinical Oncology.