Bone marrow transplantation for myelodysplasia and secondary acute nonlymphoblastic leukemia.

Abstract

Twenty-three patients with primary myelodysplasia (MDS) or secondary myelodysplasia/acute nonlymphocytic leukemia (MDS/ANLL) were treated with allogeneic or syngeneic bone marrow transplantation (BMT). Only one patient was in a chemotherapy-induced hematologic remission. Graft-versus-host disease prophylaxis included methotrexate, methotrexate plus cyclosporine, cyclosporine, or T-cell depletion using one of two anti-CD5 monoclonal antibodies. For patients with primary MDS, the median age was 19 years (range, 11 to 41 years) and the actuarial disease-free survival was 56% +/- 21% (median follow-up, 2 years; range, 0.8 to 5 years). There were three graft failures (two with autologous recovery) and two early deaths. Outcome appeared to be related to French-American-British (FAB) classification. For patients with secondary MDS/ANLL, the median age was 28 years (range, 3 to 16 years) and the actuarial disease-free survival was 27% +/- 13% (median follow-up, 5 years; range, 2.5 to 8.5 years). There were no graft failures, two relapses, and four early deaths. The presence of marrow fibrosis per se did not predict for graft failure (P = .21); however, the use of T-cell depleted marrow in patients with marrow fibrosis resulted in graft failure in three of five individuals. Our results suggest that in patients with primary MDS or secondary MDS/ANLL, BMT should be considered early in the course of the disease, and that attempts at inducing a remission prior to BMT appeared to be unnecessary. In MDS patients with marrow fibrosis, T-cell depletion should be avoided.

Allogeneic bone marrow transplantation improves the outcome of de novo AML with trilineage dysplasia (AML-TLD)

“…Meanwhile, the outcome of allogeneic BMT for sAML was also reported to be worse than that for de novo AML. 23,24 Prolonged disease-free survival can be expected in only about 20% of patients transplanted for sAML. 25 Anderson et al 26 also reported that the 5-year survival of secondary AML patients was 24.4% after stem cell transplantation.…”

Unrelated bone marrow transplantation in patients with myelodysplastic syndromes and secondary acute myeloid leukemia: an EBMT survey

“…Actuarial diseasefree survival (DFS) ranges between 35 and 45% at 2 to 4 years after BMT. [4][5][6][7][8] About 30% of younger patients with MDS/sAML will have an HLA-identical sibling donor and about 5% a one HLA locus mismatched family donor. Increasing size of the voluntary unrelated donor registries facilitates the identification of matched unrelated donors for about 75% of patients.…”

Reduced-toxicity conditioning with treosulfan, fludarabine and ATG as preparative regimen for allogeneic stem cell transplantation (alloSCT) in elderly patients with secondary acute myeloid leukemia (sAML) or myelodysplastic syndrome (MDS)

“…Disease-free survival ranges from 29 to 40% with a corresponding nonrelapse mortality of 37-50% and a rate of relapse ranging from 23-48% if the donor is an HLA-identical sibling. [1][2][3] If unrelated donors were used, after standard myeloablative conditioning the treatmentrelated mortality exceeded more than 50%. 4 Despite an improvement in the results of allogeneic stem cell transplantation during the past decade mainly due to a lower treatment-related mortality, there is still a high morbidity, which makes allogeneic stem cell transplantation after standard conditioning only appropriate for younger patients with good performance status.…”