Incidence and characterization of secondary myelodysplastic syndromes following autologous transplantation

Background and Objectives. Secondary myelodysplastic syndromes (sMDS) and s econdary acute myeloid leukemias (sAML) have been observed after convention al chemo/radiotherapy and autologous hematopoietic stem cell transplantatio n. The aim of the present study was to analyze Spanish experience regarding the incidence and characteristics of sMDS and sAML following autologous tr ansplantation. Design and Methods. We obtained information from 7 institutions which perfo rm autologous transplantation in Spain. Data from 1,081 and 1,411 patients who had received allogeneic and autologous transplantation, respectively, w ere available. Results. None of the allografted patients had developed opened a sMDS/sAML so far. Thirteen cases of sMDS/sAML following autologous transplantation we re reported. The mean age of these 13 patients at the time of transplantati on was 40 years (range 16-58). Five had non-Hodgkin's lymphoma, 6 had Hodgk in's disease, 1 had acute myeloblastic leukemia and 1 had multiple myeloma, The crude overall incidence of sMDS/sAML was 0.9%. The incidence did not d iffer according to the source of progenitor cells (1% and 0.8% for bone mar row and peripheral blood, respectively). Cytogenetic analysis showed clonal abnormalities in 11 of the 13 cases. Patients with sMDS/sAML had received more doses of alkylating agents than non-sMDS patients (p = 0.0015). The me dian time between transplantation and diagnosis of sMDS/sAML was 28 months (range 1.5-63). This time was significantly longer for patients who receive d bone marrow than for those who received peripheral blood (45 versus 18 mo nths, p = 0.01). Median overall survival after diagnosis of sMDS/sAML was 1 3 months. Interpretation and Conclusions. The crude incidence of sMDS/sAML in our ser ies was similar to other published incidences. We did not find any differen ce in incidence between patients who had received bone marrow or peripheral blood; however, the median elapsed between transplantation and sMDS is was shorter when peripheral blood was infused. Higher doses of alkylating agen ts were associated with the appearance of sMDS/AML. (C) 2000, Ferrata Stort i Foundation.