title: Bone marrow transplantation for patients with myelodysplasia. Pretreatment variables and outcome.
abstract: OBJECTIVE
  To determine the efficacy of allogeneic bone marrow transplantation for severe myelodysplasia, and to identify variables predictive of outcome.
  
  
  METHODS
  Case series study.
  
  
  METHODS
  A referral-based bone marrow transplant center.
  
  
  METHODS
  Consecutive series of 59 patients with myelodysplasia or closely related disorders and either life-threatening cytopenia or a progressive increase in marrow blast percentage.
  
  
  METHODS
  Patients were treated with high-dose cyclophosphamide and total body irradiation followed by allogeneic bone marrow transplantation from either an HLA-identical (n = 45) or HLA-partially matched (n = 14) donor.
  
  
  RESULTS
  The product-limit estimate for disease-free survival 3 years after transplant is 45% (95% CI, 32% to 59%). The commonest causes of death after transplant were disease recurrence, interstitial pneumonia, and graft-versus-host disease, accounting for eight deaths each. In a univariate analysis, younger patients, those with shorter disease duration, and those whose disease was characterized by an abnormal cytogenetic karyotype had better survival and disease-free survival than the group as a whole. In a multivariate analysis, younger age and abnormal karyotype were independent predictors of improved disease-free survival and overall survival. Patients who received transplants when they had fewer blasts in their bone marrow had a decreased chance for disease recurrence when compared with patients with excess blasts.
  
  
  CONCLUSIONS
  Bone marrow transplantation offers a potential cure for many patients with myelodysplasia. Best results can be expected in younger patients who receive transplants relatively early in their disease course.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: J
authors.initials: J
authors.lastname: Barrall
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: L D
authors.initials: LD
authors.lastname: Fisher
authors.forename: G
authors.initials: G
authors.lastname: Schoch
authors.forename: R E
authors.initials: RE
authors.lastname: Ramberg
authors.forename: H
authors.initials: H
authors.lastname: Shulman
authors.forename: C
authors.initials: C
authors.lastname: Anasetti
authors.forename: S I
authors.initials: SI
authors.lastname: Bearman
authors.forename: P
authors.initials: P
authors.lastname: Beatty
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007621:Karyotyping; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012008:Recurrence; D014916:Whole-Body Irradiation
chemical_list: D003520:Cyclophosphamide; D002066:Busulfan