Analysis of prognostic factors for allogeneic marrow transplantation following busulfan and cyclophosphamide in myelodysplastic syndrome and after leukemic transformation

Prognostic factors in 42 patients aged 11 to 62 (median 46) years, with mye lodysplastic syndrome (MDS) or after leukemic transformation, who underwent allogeneic marrow transplantation between 1984 and 1999 were analyzed. Thi rty-six had advanced disease morphology; 19 had leukemic transformation. Tw enty-nine received a preparative regimen of BuCy2 and 13 busulfan 14 mg/kg, etoposide 50 mg/kg and cyclophosphamide 120 mg/kg. Severe hepatic veno-occ lusive disease (VOD) occurred in three patients all of whom received anti-l eukemic chemotherapy prior to transplantation. Fifteen patients (36%) died from early transplant-related complications; nine patients relapsed. The es timated 4 year disease-free survival (DFS) was 35% (95% CI 26-44%). Older a ge was the most significant adverse prognostic factor. Patients with leukem ic transformation who underwent early transplantation had significantly bet ter DFS than those treated first with chemotherapy (P = 0.002). Delayed tox icity was rare in these patients; no late relapses occurred.