Outcome of allo-SCT for women with MDS or AML occurring after breast cancer therapy

Abstract

Women with breast cancer who receive adjuvant therapy are at risk for developing therapy-related myelodysplastic syndrome (MDS) or AML (tMDS/AML). Patients with tMDS/AML are often referred for consideration of allogeneic hematopoietic SCT (HSCT). However, the outcomes of HSCT in such patients have not been well described. We report a retrospective study of all women who were treated with HSCT for MDS or AML at our institution between 1991 and 2008. We compared the transplantation outcomes for 24 women with a history of breast cancer with those for 271 women with de novo disease. Three-year OS and disease-free survival (DFS) for patients with a history of breast cancer were 41 and 45%, respectively. The cumulative incidences of tMDS/ AML relapse and non-relapse mortality (NRM) were 38 and 17%, respectively. Those outcomes were very similar to those of patients with de novo disease. In multivariable analyses, a history of breast cancer had no impact on OS, DFS, relapse or NRM. A significant proportion of women with tAML/MDS after breast cancer treatment experience DFS after HSCT, similar to that of patients with de novo MDS or AML. This justifies consideration of HSCT for selected patients in this setting.

Routine clinical parameters and laboratory testing predict therapy-related myeloid neoplasms after treatment for breast cancer

“…At the same time, the decision whether to perform a BMBx was also determined by the evaluation of the hematologist. This most likely accounts for the extremely high incidence of t-MN that is inconsistent with the incidence of 0.1-1.8% reported in prior works 2,8,50 . Moreover, our study involves only the population of one center and may not be applicable to other centers.…”

Long-term follow-up of therapy-related myelodysplasia and AML patients treated with allogeneic hematopoietic cell transplantation

“…6,7,[13][14][15][16] Here we present a retrospective long-term followup analysis of 79 unselected consecutive t-MDS/t-AML patients who underwent aHCT after predominantly RIC (73.4%) between 1995 and 2014. With a median follow-up of 7.5 years, this is one of the longest reported follow-up studies for this specific patient clientele, revealing a 10 year OS and DFS rate of 24% (13-36%) and 24% (14-36%), respectively, whereas the NRM rate was 32% (22-46%).…”

ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN THERAPY-RELATED MYELOID NEOPLASMS (t-MN) OF THE ADULT: MONOCENTRIC OBSERVATIONAL STUDY AND REVIEW OF THE LITERATURE.

“… 50 , 51 , 67 , 68 Reduced intensity conditioning and conditioning with targeted busulphan dose 38 , 51 , 58 might reduce TRM, especially for those patients with a reduced organ reserve. As reported for patients with de novo MDS, 69 pre-transplant disease stage, cytogenetic risk group, 57 , 56 type of therapy given for the original disease, transplant conditioning regimen, and patient age 61 significantly affect relapse-free survival among patients with secondary MDS/t-AML. 38 Concerning to stem cell source, peripheral blood instead of bone marrow appeared to reduce NRM 38 and relapse rate 38 , 57 and to improve OS.…”

“…The mainly predicting factor for OS resulted the karyotype and the recipient performance status at transplant. 38 , 54 , 56 Patients achieving a CR before transplantation showed better outcomes, whereas multiple therapy lines increase organ damage as well as the incidence of neutropenia, infection events and the immunosuppression of the patient increase TRM. 54 , 60 , 61 Patients at risk for treatment-related myeloid neoplasms should be followed closely and be considered for stem-cell transplantation early in the course of myelodysplasia.…”