Diagnosis of secondary myelodysplastic syndromes (MDS) following autologous transplantation should not be based only on morphological criteria used for diagnosis of de novo MDS

Abstract

Summary:Secondary myelodysplastic syndromes (MDS) are increasingly being reported after autologous transplantation. Transient dysplastic changes have also been observed after this type of treatment. However, to the best of our knowledge no systematic morphological analysis has been perfomed to determine the influence of stem cell transplantation on bone marrow morphology. In 53 patients undergoing autologous transplantation, we evaluated the bone marrow, before and 6 and 12 months after the transplant, in order to analyze the appearance of dyshemopoietic changes, assessed according to a pre-established score. We also studied 25 bone marrow samples obtained at the time of diagnosis, prior to treatment, but we did not find morphological atypia. Six months after transplant, cellularity and thrombopoiesis had decreased in 38% and 49% of patients respectively, although 1 year after the process they were normal in most cases. Myelodysplasia was already present in bone marrow before transplantation and continued to be in evidence for a long time afterwards. This suggests that chemotherapy and radiotherapy used prior to transplantation are responsible for dysplastic changes. The myeloid line was the most affected with 100% of patients showing dysgranulopoiesis 1 year after autografting. Cytopenias were observed in 51% and 44% of patients 6 and 12 months after transplantation. Moreover, concomitant presence of cytopenia and myelodysplasia was observed in 37.7% of patients at 6 months after transplantation and 25% at 12 months, and therefore they could be diagnosed with MDS. These data contrast with the incidence of secondary MDS reported in earlier publications. According to these findings, the value of the FrenchAmerican-British Co-operative Group criteria for the diagnosis of MDS following autologous transplantation is questionable. Moreover, since dyshemopoietic features are almost always present after autologous transplant, morphological criteria are not useful for early

Therapy‐related myelodysplasia and/or acute myeloid leukaemia after autologous haematopoietic progenitor cell transplantation in a prospective single centre cohort of 221 patients

“…The time elapsed between diagnosis and transplant and, therefore, the duration of previous chemotherapy is also a determining factor. It is important to take into account the fact that the diagnosis of MDS after stem cell transplantation is puzzling, because transient cytopenias with various degrees of bone marrow dysplasia have been observed: dyserythropoiesis is almost constant (Rozman et al , 1982; Soligo et al , 1998; Amigo et al , 1999), and dysmegakaryocytopoiesis is very frequent and mostly predictive of a clonal evolution (Wilson et al , 1997). In addition, the frequency of trilineage myelodysplasia, hypoplastic forms and forms with medullar fibrosis is also problematic for diagnosis, as underlined by Laurenti et al (2000).…”

Treatment-related myelodysplastic syndrome/acute myeloid leukemia in survivors of childhood cancer – An update

“…Within the new WHO classification, this may increase inconsistencies in the classification of patients with t-MDS [43]. In addition, blood and bone marrow of some patients following stem cell transplantation may have dysplastic features [47,48] without evolution to fulfil the diagnostic criteria for MDS/AML [41,48]. Such patients may have evidence of transient abnormal clonal hematopoiesis [49,50].…”

Low incidence of secondary neoplasia after autotransplantation for lymphoproliferative disease: the role of pre‐transplant therapy

“… The use of chemo‐radiotherapy or biological response modifiers after autotransplant for progression disease requiring treatment. Cytogenetical alteration before conditioning regimen. Low risk MDS in absence of cytogenetic alteration (refractory anemia; refractory anemia with ringer sideroblast, refractory cytopenia with multilineage dysplasia, refractory cytopenia with multilineage dysplasia with riger sideroblasts) during the first 12 months after aPBSCT because of mild hematopoietic cell atipia and dysplastic feature are common after chemotherapy and could be confused with MDS as reported by Amigo et al. and our group (20, 21). …”

“…Amigo et al. in 1999 (20) published a report in which the application of French American British (FAB) criteria for diagnosis of especially low‐risk MDS in the early period after transplant is questionable. Their data showed, until 12 months after autografting, dysgranulopoiesis in 100%, cytopenias in 44%, and concomitant presence of cytopenia and myelodysplasia in 25% of patients which could be diagnosed with MDS (20, 21).…”