title: Allogeneic bone marrow transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia: a long-term study of 70 patients-report of the French society of bone marrow transplantation.
abstract: OBJECTIVE
  To identify predictive factors of survival, relapse, and transplantation-related mortality (TRM) among patients with therapy-related myelodysplastic syndrome (t-MDS) or acute leukemia (t-AML) who underwent allogeneic bone marrow transplantation (BMT).
  
  
  METHODS
  From 1980 to 1998, 70 patients underwent allogeneic BMT for t-MDS (n = 31) or t-AML (n = 39) after prior cytotoxic exposure. Thirty-three patients had received induction-type chemotherapy before BMT. At the time of transplantation, there were 24 patients in complete remission (CR) and 46 with active disease.
  
  
  RESULTS
  With a median follow-up of 7.9 years (range, 1.1 to 18.8 years) after BMT, 16 patients are alive, whereas 19 died of relapse, 34 of TRM, and one of relapse of the primary disease. The estimated 2-year overall survival, event-free survival, relapse, and TRM rates were 30% (95% confidence interval [CI], 19% to 40%), 28% (95% CI, 18% to 39%), 42% (95% CI, 26% to 57%), and 49% (95% CI, 36% to 62%), respectively. In multivariable analysis, age greater than 37 years, male sex, positive recipient cytomegalovirus (CMV) serology, absence of CR at BMT, and intensive schedules used for conditioning were associated with poor outcome.
  
  
  CONCLUSIONS
  BMT is an effective treatment for patients with t-MDS or t-AML who have responsive disease and, in particular, who have no poor-risk cytogenetic features. The poor results of the other patients, especially those with active disease at BMT, emphasize the need to delineate indications and perform prospective protocols.
authors.affiliation: Service d'Hématologie Clinique et Greffe de Moelle Osseuse and Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: P
authors.initials: P
authors.lastname: de La Salmonière
authors.forename: P
authors.initials: P
authors.lastname: Ribaud
authors.forename: L
authors.initials: L
authors.lastname: Sutton
authors.forename: E
authors.initials: E
authors.lastname: Wattel
authors.forename: M
authors.initials: M
authors.lastname: Kuentz
authors.forename: J P
authors.initials: JP
authors.lastname: Jouet
authors.forename: G
authors.initials: G
authors.lastname: Marit
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.forename: E
authors.initials: E
authors.lastname: Deconinck
authors.forename: N
authors.initials: N
authors.lastname: Gratecos
authors.forename: M
authors.initials: M
authors.lastname: Leporrier
authors.forename: I
authors.initials: I
authors.lastname: Chabbert
authors.forename: D
authors.initials: D
authors.lastname: Caillot
authors.forename: G
authors.initials: G
authors.lastname: Damaj
authors.forename: C
authors.initials: C
authors.lastname: Dauriac
authors.forename: F
authors.initials: F
authors.lastname: Dreyfus
authors.forename: S
authors.initials: S
authors.lastname: François
authors.forename: L
authors.initials: L
authors.lastname: Molina
authors.forename: M L
authors.initials: ML
authors.lastname: Tanguy
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D005260:Female; D005602:France; D006801:Humans; D007947:Leukemia, Megakaryoblastic, Acute / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis; D014184:Transplantation, Homologous