Risk Factors Before Autologous Stem-cell Transplantation for Lymphoma Predict for Secondary Myelodysplasia and Acute Myelogenous Leukemia.
From: Department of Hematology, The Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, OH, USA. kalaycm@ccf.org
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publish Date: Aug 2006
- ISSN: 1527-7755
- Volume: 24
- Issue: 22
- Pages: 3604-10
- Medium: Internet
- Language: English
- Citation (JAMA): Kalaycio Matt, Rybicki Lisa, Pohlman Brad, et al. Risk Factors Before Autologous Stem-cell Transplantation for Lymphoma Predict for Secondary Myelodysplasia and Acute Myelogenous Leukemia.. J. Clin. Oncol. Aug 2006;24:3604-10
Abstract
PURPOSE: The risk factors for treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (AML) after autologous stem-cell transplantation (ASCT) are similar to those that increase the risk of difficult stem-cell harvests. We reviewed our experience in 526 patients with lymphoma treated by ASCT to determine whether difficult stem-cell harvests predict for an increased risk of t-MDS/AML. PATIENTS AND METHODS: Autologous peripheral stem cells were initially mobilized with granulocyte colony-stimulating factor (G-CSF; or granulocyte-macrophage colony-stimulating factor) alone (n = 334), etoposide and G-CSF (n = 166), or cyclophosphamide and G-CSF with or without etoposide (n = 26). Difficult harvests were those that required more than 5 days to collect enough stem cells and those that required additional attempts with etoposide and/or cyclophosphamide plus G-CSF (n = 52). All patients were then treated with high-dose chemotherapy alone and observed for outcome. RESULTS: With a median follow-up time for surviving patients of 69 months, 20 patients developed t-MDS/AML, for an actuarial incidence of 6.8% at 10 years. Pretransplantation characteristics, including age, diagnosis of non-Hodgkin’s lymphoma or Hodgkin’s disease, bone marrow involvement, prior radiation therapy, prior exposure to chemotherapy, lactate dehydrogenase at the time of ASCT, disease status, and method of stem-cell mobilization, were then analyzed with respect to the subsequent development of t-MDS/AML. By multivariable analysis, prior exposure to radiation therapy, four or more chemotherapy regimens, and more than 5 days of apheresis needed to harvest enough stem cells were identified as independent risk factors for t-MDS/AML. Bootstrap analysis confirmed these results. CONCLUSION: These results suggest that identifiable pretransplantation factors predict for t-MDS/AML after ASCT.
Mesh Headings (Keywords): Actuarial Analysis, Adolescent, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Chemotherapy, Adjuvant, Female, Granulocyte Colony-Stimulating Factor, Hematopoietic Stem Cell Mobilization, Humans, Incidence, Leukemia, Myeloid, Acute, Lymphoma, Male, Middle Aged, Multivariate Analysis, Myelodysplastic Syndromes, Peripheral Blood Stem Cell Transplantation, Predictive Value of Tests, Retrospective Studies, Risk Factors, Survival Analysis, Transplantation, Autologous
Check for Full Text / PubMed Unique Identifier (PMID): 16877727
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