SECONDARY MYELODYSPLASIA AND ACUTE-LEUKEMIA IN BREAST-CANCER PATIENTSAFTER AUTOLOGOUS BONE-MARROW TRANSPLANT

Purpose: To determine the incidence of myelodysplasia (MDS) and/or acu te leukemia (AL) in breast cancer patients after high-dose chemotherap y (HDC) with a single conditioning regimen and autologous bone marrow transplant (ABMT), and analyze the cytogenetic abnormalities that aris e after HDC. Patients and Methods: We retrospectively reviewed the rec ords of 864 breast cancer patients who underwent ABMT at Duke Universi ty Medical Center, Durham, NC, from 1985 through 1996 who received the same preparative regimen of cyclophosphamide 1,875 mg/m(2) for 3 days , cisplatin 55 mg/m(2) for 3 days, and BCNU 600 mg/m(2) for 1 day (CPB ). Pretransplant cytogenetics were analyzed in all patients and posttr ansplant cytogenetics were evaluated in four of five patients who deve loped MDS/AL. Results: Five of 864 patients developed MDS/AL after HDC with CPB and ABMT. The crude cumulative incidence of MDS/AL was 0.58% . The Kaplan-Meier curve shows a 4-year probability of developing MDS/ AL of 1.6%. Pretransplant cytogenetics performed on these five patient s were all normal. Posttransplant cytogenetics were performed on four of five patients and they were abnormal in all four, although only one patient had the most common cytogenetic abnormality associated with s econdary MDS/AL (chromosome 5 and/or 7 abnormality). Conclusion: Where as MDS/AL is a potential complication of HDC with CPB and ABMT, the in cidence in this series of patients with breast cancer was relatively l ow compared with that reported in patients with non-Hodgkin's lymphoma who underwent ABMT. The cytogenetic abnormalities reported in this gr oup of breast cancer patients were not typical of those seen in prior reports of secondary MDS/AL and appear to have occurred after HDC. (C) 1998 by American Society of Clinical Oncology.