title: Bone marrow transplantation for therapy-related myelodysplasia: comparison with primary myelodysplasia.
abstract: Therapy-related myelodysplasia (MDS) is a fatal marrow disorder distinct from primary MDS. We examined the efficacy of bone marrow transplantation (BMT) as a treatment for patients with therapy-related MDS. Eighteen patients with therapy-related MDS and twenty-five patients with primary MDS received an allogeneic, syngeneic, or unrelated donor BMT. Graft-versus-host disease prophylaxis included methotrexate, methotrexate plus cyclosporine, FK-506, or T cell depletion. Conditioning regimens consisted of cyclophosphamide/total body irradiation, with and without cytosine arabinoside, busulfan/cyclophosphamide, and cyclophosphamide/etoposide/carmustine. For patients with therapy-related MDS, the median age was 32 years and the actuarial disease-free survival was 24% (95% confidence interval 6, 42%) with a median follow-up of 3 years. For patients with primary MDS, the median age was 36 years and the actuarial disease-free survival at 3 years was 43% (95% confidence interval 22, 64%). Four of the therapy-related patients and two of the primary patients have relapsed. Three patients experienced graft failure; all three had received T cell-depleted marrow and two had marrow fibrosis. Our results suggest that patients with therapy-related MDS can be successfully transplanted. Transplantation should be considered early in the disease, since long-term disease-free survival is achievable.
authors.affiliation: Cancer Center, University of Massachusetts Medical Center, Worcester 01655, USA.
authors.forename: K K
authors.initials: KK
authors.lastname: Ballen
authors.forename: D G
authors.initials: DG
authors.lastname: Gilliland
authors.forename: E C
authors.initials: EC
authors.lastname: Guinan
authors.forename: C C
authors.initials: CC
authors.lastname: Hsieh
authors.forename: S K
authors.initials: SK
authors.lastname: Parsons
authors.forename: I J
authors.initials: IJ
authors.lastname: Rimm
authors.forename: J L
authors.initials: JL
authors.lastname: Ferrara
authors.forename: B E
authors.initials: BE
authors.lastname: Bierer
authors.forename: H J
authors.initials: HJ
authors.lastname: Weinstein
authors.forename: J H
authors.initials: JH
authors.lastname: Antin
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate