Hematopoietic stern-cell transplantation for treatment-related leukemia ormyelodysplasia

Purpose: This report describes results of related or unrelated hematopoieti c stem-cell transplants in 111 patients with treatment-related leukemia or myelodysplasia performed consecutively at the Fred Hutchinson Cancer Resear ch Center between December 1971 and June 1998, and identifies patient and t reatment characteristics associated with survival and relapse. Patients and Methods: At transplantation, 56 patients had treatment-related secondary acute myeloid leukemia (AML), 15 herd refractory anemia with exc ess blasts in transition (RAEB-T), 23 had refractory anemia with excess bla sts (RAEB), 15 had refractory anemia (RA) and two had refractory anemia wit h ringed sideroblasts (RARS), Conditioning regimens were total-body irradia tion (TBI) and chemotherapy for 60 patients, busulfan (BU) 14 to 16 mg/kg a nd cyclophosphamide (CY) 120 mg/kg ((BUCY) for 27 patients, BU targeted to 600 to 900 ng/mL plasma steady-state concentration with 120 mg/kg CY (BUCY- t) for 22 patients, and miscellaneous chemotherapy for two patients. The do nors were HLA-identical or partially identical family members for 69 patien ts and unrelated donors for 42 patients. Results: The 5-year disease-free survival was 8% for TBI, 19% for BUCY, and 30% for BUCY-t (P = .006). The 5-year cumulative incidence of relapse was 40% for secondary AML, 40% for RAEB-T, 26% for RAEB, and 0% for RA or PARS (P = .0009). The 5-year cumulative incidence of nonrelapse mortality after TBI was 58%; after BUCY, 52%; and after BUCY-t, 42% (P = .02), Conclusion: Patients at risk for treatment-related leukemia or myelodysplas ia should be followed closely and be considered for stem-cell transplantati on early in the course of myeladysplasia using conditioning regimens such a s BUCY-t designed to reduce nonrelapse mortality. (C) 2001 by American Soci ety of Clinical Oncology.