Bone marrow transplantation for therapy-related myelodysplasia: comparison with primary myelodysplasia

Abstract

Summary:use of intensive chemotherapy, the incidence of therapyrelated MDS is rising. [4][5][6][7] There are also recent reports of therapy-related MDS occurring after autologous transplants Therapy-related myelodysplasia (MDS) is a fatal marrow disorder distinct from primary MDS. We examined for lymphoma and breast cancer. 8-10The prognosis for patients with therapy-related MDS is the efficacy of bone marrow transplantation (BMT) as a treatment for patients with therapy-related MDS.poor. The median survival is 4 months, with deaths due to infection, bleeding, or progression to acute leukemia. 5,7,11Eighteen patients with therapy-related MDS and twenty-five patients with primary MDS received an alloThe prognosis for primary MDS is better, with a median survival of 15 months. 2 However, the outcome is variable geneic, syngeneic, or unrelated donor BMT. Graft-versus-host disease prophylaxis included methotrexate, and the prognosis depends on blast percentage, cytogenetic abnormalities, platelet count and on stage of disease as methotrexate plus cyclosporine, FK-506, or T cell depletion. Conditioning regimens consisted of described by French-American-British (FAB) classification. 12,13cyclophosphamide/total body irradiation, with and without cytosine arabinoside, busulfan/cyclophosTreatment for therapy-related MDS has included intensive induction therapy similar to the regimens used for phamide, and cyclophosphamide/etoposide/carmustine. For patients with therapy-related MDS, the median age acute myelogenous leukemia. These regimens have induced a remission in 60% of patients but the remission duration is was 32 years and the actuarial disease-free survival was 24% (95% confidence interval 6, 42%) with a median only a few months and the overall survival is poor. 14-16 Other approaches have included retinoids, 5-azacytidine, cytosine follow-up of 3 years. For patients with primary MDS, the median age was 36 years and the actuarial diseasearabinoside, growth factors, and hormonal agents, all with no improvement in survival. 17-22free survival at 3 years was 43% (95% confidence interval 22, 64%). Four of the therapy-related patients and Bone marrow transplantation (BMT) is effective therapy for selected patients with primary MDS. [23][24][25][26] The value of two of the primary patients have relapsed. Three patients experienced graft failure; all three had received BMT in patients with therapy-related MDS has been difficult to assess because the number of reported cases is small. T cell-depleted marrow and two had marrow fibrosis. Our results suggest that patients with therapy-relatedIn addition, data for therapy-related MDS have been shown together with primary MDS, making the relative utility of MDS can be successfully transplanted. Transplantation should be considered early in the disease, since longtransplantation for the two diseases difficult to determine. [26][27][28][29][30] In this study, we examine the long-term outcome term disease-free survival is achievable. Keywords: myelodysplasia; bone marrow transplan...

Bone marrow transplantation for therapy-induced acute myeloid leukemia in children with previous lymphoid malignancies

“…The outcome after bone marrow transplant for therapy-related AML is also poor. A study from Seattle reported a 5-year DFS of 7.8% for 17 adults patients with therapy-related AML 17 while Ballen et al 18 reported 24% DFS at 3 years. For pediatric patients with epipodophyllotoxin-induced AML, Sandler et al 7 reported eight patients receiving allogeneic transplants and two patients receiving autografts after previous therapy for ALL.…”

Erythroleukemia: a need for a new definition

“…18 Even for therapy-related myelodysplasia, transplantation seems to be favorable for long-term disease-free survival. 19 …”

Autologous stem cell transplantation for therapy-related acute myeloid leukemia and myelodysplastic syndrome

“…13 In a small single-center study including 18 patients with MDS, the disease-free survival after allogeneic stem cell transplantation was only 24% for t-MDS in comparison to 43% for primary MDS. 16 However, one might keep in mind that the patient population in our study is highly selected including mostly patients with AML at diagnosis, who were chemosensitive and in CR at the time of transplantation. Similar to the reported risk factor for allogeneic stem cell transplantation in t-MDS/t-AML, 13 lower age and CR are most important risk factors for OS after autologous stem cell transplantation.…”

“…10 In a review of 644 patients with t-AML treated with standard-AML-induction protocols, only 28% achieved a CR. 11 Importantly, a small number of patients with t-AML who have favorable cytogenetic abnormalities, such as t(8;21), t(15;17), or inv (16), have a considerably better outcome, not markedly different from the high response rate observed with the same abnormalities in de novo AML. 12 Allogeneic stem cell transplantation is proposed to be the only curative treatment approach in t-MDS/AML.…”

“…[4][5][6] This type of AML usually occurred after a median of 2 years and is not preceded by a MDS. According to the French-American-British (FAB) classification, M4 or M5 is observed more frequently, and cytogenetic analysis showed a high frequency of rearrangements of chromosome band 11q23, t(8;21), t(15;17), inv (16), or t (8;16) as in de novo AML. 6,7 Primary MDS, AML after MDS, and t-MDS/-AML share biologic and clinical features, but t-MDS/AML has a more rapidly progressive disease and a worse response to chemotherapy.…”