Secondary acute myeloid leukemia and myelodysplasia after autologous peripheral blood progenitor cell transplantation.
Secondary myelodysplastic syndrome (MDS) and acute leukemia (AL) are well-known complications of antineoplastic therapy. The incidence of these serious complications after autologous hematopoietic transplantation ranges from 1.1% to 24%. Prior chemotherapy is its most likely cause, but other variables related to these long-term complications are seriously discussed. There is evidence that priming of progenitor cells isolated from peripheral blood with chemotherapy is also related to a higher risk of secondary MDS/AL. Whether progenitor cells isolated from bone marrow or peripheral blood after mobilization only with cytokines are related to higher risk is a controversial issue. In this paper, we analyze the incidence and variables related to these complications in a series of 99 patients diagnosed with lymphoma or multiple myeloma who underwent autologous transplantation using hematopoietic progenitors isolated from peripheral blood mobilized with granulocyte colony-stimulating factor (G-CSF). The probability of MDS/AL in patients alive 5 years after transplant in our series is 8.58%, similar to that reported in other series using bone marrow grafts. The total dose of cyclophosphamide ( p=0.099), the number of chemotherapy cycles ( p=0.04) received before transplant, and the total dose of mononuclear cells infused at the time of transplant were the only variables associated with secondary MDS/AL. Autologous transplantation with progenitor cells isolated from peripheral blood after mobilization with cytokines has probability and risk factors for secondary MDS/AL development similar to bone marrow grafts when compared with other published series.
Sevilla
J
J
Banco de Sangre, Hospital Niño Jesús, Av/Menéndez Pelayo 65, Madrid 28009, Spain. jsevilla@hnjs.insalud.es
Rodríguez
A
A
Hernández-Maraver
D
D
de Bustos
G
G
Aguado
J
J
Ojeda
E
E
Arrieta
R
R
Hernández-Navarro
F
F
D000208:Acute Disease; D000328:Adult; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006689:Hodgkin Disease / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007951:Leukemia, Myeloid / Q000209:etiology* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000209:etiology* / Q000473:pathology; D016609:Neoplasms, Second Primary; D014182:Transplantation, Autologous