title: High incidence of myelodysplasia and secondary leukaemia in the UK Medical Research Council Pilot of autografting in chronic lymphocytic leukaemia.
abstract: We report a high incidence of myelodysplastic syndrome (MDS)/acute myeloid leukaemia (AML) in patients entered into the preceding Medical Research Council Chronic Lymphocytic Leukaemia Pilot study of autografting [corrected] Of 115 newly diagnosed patients treated with fludarabine, 65 patients proceeded to autologous transplant. Conditioning was cyclophosphamide and total body irradiation in 49 (75%) patients and chemotherapy in 12 (18%). Ten patients have developed MDS/AML; eight had undergone an autograft. Five-year actuarial risk of developing MDS/AML postautograft was 12.4% (95% confidence interval, 2.5-24%). No analysed potential risk factor was predictive for MDS/AML development. We hypothesise that potential causative factors are fludarabine, low cell dose and transplant conditioning.
authors.affiliation: Department of Haematology, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. d.w.milligan@bham.ac.uk
authors.forename: Donald W
authors.initials: DW
authors.lastname: Milligan
authors.forename: Geothy
authors.initials: G
authors.lastname: Kochethu
authors.forename: Claire
authors.initials: C
authors.lastname: Dearden
authors.forename: Estella
authors.initials: E
authors.lastname: Matutes
authors.forename: Christopher
authors.initials: C
authors.lastname: MacConkey
authors.forename: Daniel
authors.initials: D
authors.lastname: Catovsky
mesh_terms: D000208:Acute Disease; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000209:etiology*; D007951:Leukemia, Myeloid / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D001084:Vidarabine Phosphate / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000964:Antimetabolites, Antineoplastic; D001084:Vidarabine Phosphate; C042382:fludarabine phosphate