Predictors of outcome following myeloablative allo-SCT for therapy-related myelodysplastic syndrome and AML.
Administration of alkylating agents (Alk), topoisomerase II inhibitors (Topo II) and radiotherapy (RT) can result in therapy-related myelodysplastic syndrome or acute myelogenous leukaemia (t-MDS/t-AML), the optimal treatment for which is allo-SCT. A retrospective review was performed of 24 patients who underwent related- or unrelated-donor SCT for t-MDS/t-AML at our institution. Eight patients remain alive and in continuous remission (median follow-up 54 months (range, 12-161)) with estimated 5-year EFS being 30% (95% confidence intervals 16-58%). Corresponding actuarial risks of relapse and non-relapse mortality (NRM) are 39% (19-60%) and 30% (13-50%), respectively. EFS was 40% in Alk/RT-related t-MDS/t-AML and 11% in Topo II-related t-MDS/t-AML (P=0.05), with an increased risk of relapse in the latter (56 vs 29%, respectively (P=0.05)). In multivariate analysis, development of acute GVHD (P=0.009) and Topo II-related t-MDS/t-AML (P=0.018) were associated with inferior EFS. Patients with acute GVHD had an increased risk of NRM (P=0.03) whereas risk of relapse was higher for patients of advanced age (P=0.046) and for patients who underwent bone marrow (vs blood) SCT (P=0.032). Allo-SCT can result in long-term survival for individuals with t-MDS/t-AML although outcome in Topo II-related t-MDS/t-AML patients remains suboptimal.
Nevill
T J
TJ
The Leukaemia Bone Marrow Transplantation Program of British Columbia, Division of Hematology, Vancouver General Hospital, Vancouver, British Columbia, Canada. tnevill@bccancer.bc.ca
Hogge
D E
DE
Toze
C L
CL
Nantel
S H
SH
Power
M M
MM
Abou Mourad
Y R
YR
Song
K W
KW
Lavoie
J C
JC
Forrest
D L
DL
Barnett
M J
MJ
Shepherd
J D
JD
Nitta
J Y
JY
Wong
S
S
Sutherland
H J
HJ
Smith
C A
CA
D000328:Adult; D000477:Alkylating Agents / Q000009:adverse effects; D004791:Enzyme Inhibitors / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000009:adverse effects*; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000628:therapy*; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D059005:Topoisomerase II Inhibitors; D016896:Treatment Outcome; D055815:Young Adult
D000477:Alkylating Agents; D004791:Enzyme Inhibitors; D019653:Myeloablative Agonists; D059005:Topoisomerase II Inhibitors