Myelodysplasias and leukemias after autologous stem cell transplantation for lymphoid malignancies

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.