MYELODYSPLASTIC SYNDROME OCCURRING AFTER AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR LYMPHOMA - MORPHOLOGIC FEATURES

Clonal karyotypic abnormalities characteristic of myelodysplastic synd rome (MDS) occur in up to 18% of patients who undergo autologous bone marrow transplantation (auto-BMT) for the treatment of lymphoma. Morph ologic changes are often subtle and may not meet the French-American-B ritish Cooperative Group criteria for MDS. We retrospectively assessed dysplastic changes in peripheral blood and bone marrow specimens obta ined before and after transplantation from nine patients and correlate d them with karyotype and survival. All patients had normal cytogeneti c study results before transplantation and had clonal karyotypic abnor malities develop after auto-BMT. Four patients (with aggressive MDS) s urvived a short time and died of acute myelogenous leukemia or MDS-rel ated complications, four (with indolent MDS) had a prolonged survival period, and one patient died of recurrent lymphoma. The group with agg ressive MDS had significantly more bone marrow trilineage dysplasia be fore auto-BMT than did the group with indolent MDS or cytogenetically normal auto-BMT controls, suggesting that stem cell damage occurred be fore transplantation and was not detected by pretransplantation cytoge netic analysis. Comparatively greater dyserythropoiesis and dysmegakar yopoiesis were present after transplantation; these changes were simil ar to those seen in de novo MDS. Posttransplantation dysplasia in the group with indolent MDS was analogous to the atypia related to the tra nsplantation process.