S. Park et al., Myelodysplasias and leukemias after autologous stem cell transplantation for lymphoid malignancies, BONE MAR TR, 26(3), 2000, pp. 321-326
Citations number
28
Categorie Soggetti
Hematology,"Medical Research Diagnosis & Treatment
The incidence of secondary myelodysplastic syndromes and acute leukemia (MD
S/AL) was reported for 395 patients autografted for Hodgkin's disease (HD)
(n = 96) and non-Hodgkin's lymphoma (NHL) (n = 299) between 1987 and 1998,
Eleven patients developed secondary MDS/AL (crude rate at 2.8%) including t
wo lymphoblastic AL cases, The mean time of occurrence was at 32 months aft
er autologous stem cell transplantation (ASCT) and 71 months after diagnosi
s, The estimated actuarial incidence at 10 years was at 6.3% (+/-4%), Karyo
typing revealed complex chromosomal aberrations in only one patient, and tw
o translocations [t(8;21) and t(8;16)], No features of topoisomerase II inh
ibitor-related leukemia were found. Only one patient had received ASCT in f
irst remission. The remaining 10 patients had received multiple courses of
chemotherapy before stem cell collection and four had relapsed after ASCT a
nd before the occurrence of secondary MDS/AL, Five of 11 patients had recei
ved localized radiotherapy and five others received TBI in their conditioni
ng regimen. Ten patients died despite chemotherapy and/or supportive care a
nd only one patient is alive and well after genoidentical allogeneic transp
lantation. We suggest a cumulative leukemogenic role of pre-ASCT radiation
and chemotherapy in the occurrence of these secondary MDS/AL more than the
high-dose therapy itself.