Myelodysplastic syndrome and acute myelogenous leukemia secondary to hearttransplantation

Myelodysplastic syndrome and acute myelogenous leukemia secondary to radiot herapy, radiation exposure, and chemotherapy is a well-documented malignant stem cell disorder. The incidence and natural course of myelodysplastic sy ndrome and acute myelogenous leukemia after organ transplantation remains l ess thoroughly investigated. In our institution, 631 heart transplantations have been performed between 1983 and 1998, We report five patients (age, 22-63 years) with myelodysplas tic syndrome (MDS) (n=1) or acute myelogenous leukemia (AML) (n=4) occuring 4-8 years after transplantation, Immunsuppression consisted uniformly of a combination of prednisone, cyclosporine, and azathioprine. Successful cyto genetic analysis was performed in three patients, showing typical cytogenet ic abnormalities in each case. The course of AML was uniformly fatal. One p atient with MDS, refractory anemia with excess of blasts according to the F AB criteria, is alive with transfusion dependency 32 months after diagnosis . MDS and AML may occur during immunosuppression after heart transplantation. Treatment results are poor in this subgroup of patients with secondary leu kemia.