Autologous stem cell transplantation for therapy-related acute myeloid leukemia and myelodysplastic syndrome.
We report the results of 65 patients with treatment-related myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML) who were transplanted from an autograft and reported to the EBMT. The median age was 39 years (range, 3-69), and stem cell source was bone marrow (n = 31), or peripheral blood progenitor cells (n = 30), or the combination of both (n = 4). The primary disease was solid tumors (n = 37), Hodgkin's disease (n = 13), non-Hodgkin's lymphoma (n = 10), acute lymphoblastic leukemia (n = 2) or myeloproliferative syndromes (n = 3). The types of MDS were as follows: RAEB (n = 1; 2%), RAEB-t (n = 3; 5%), or AML (n = 56; 87%). The median time between diagnosis and transplantation was 5 months (range, 3-86). The Kaplan-Meier estimates of the probability of 3-year overall and disease-free survival were 35% (95% CI: 21-49%) and 32% (95% CI: 18-45%), respectively. The median leukocyte engraftment was faster after transplantation with peripheral blood stem cells than with bone marrow: 12 (range, 9-26) vs 29 (range, 11-67) days (P<0.001). The cumulative incidence of relapse was 58% (95% CI: 44-72%) and of treatment-related mortality 12% (95% CI: 6-38%). Lower relapse rate was seen in patients transplanted in first complete remission (CR1 vs non-CR1: 3 years: 48 vs 89%; P = 0.05). Furthermore, age beyond 40 years resulted in a higher treatment-related mortality (47 vs 7%; P = 0.01). In a multivariate analysis, transplantation in CR1 age as well as their interaction influenced overall survival significantly. Autologous transplantation may cure a substantial number of patients with treatment-related MDS/AML, especially if they are in CR1 and of younger age.
Kröger
N
N
Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
Brand
R
R
van Biezen
A
A
Cahn
J-Y
JY
Slavin
S
S
Blaise
D
D
Sierra
J
J
Zander
A
A
Niederwieser
D
D
de Witte
T
T
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000401:mortality; D015996:Survival Rate; D014182:Transplantation, Autologous