title: Predictors of outcome following myeloablative allo-SCT for therapy-related myelodysplastic syndrome and AML.
abstract: 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.
authors.affiliation: The Leukaemia Bone Marrow Transplantation Program of British Columbia, Division of Hematology, Vancouver General Hospital, Vancouver, British Columbia, Canada. tnevill@bccancer.bc.ca
authors.forename: T J
authors.initials: TJ
authors.lastname: Nevill
authors.forename: D E
authors.initials: DE
authors.lastname: Hogge
authors.forename: C L
authors.initials: CL
authors.lastname: Toze
authors.forename: S H
authors.initials: SH
authors.lastname: Nantel
authors.forename: M M
authors.initials: MM
authors.lastname: Power
authors.forename: Y R
authors.initials: YR
authors.lastname: Abou Mourad
authors.forename: K W
authors.initials: KW
authors.lastname: Song
authors.forename: J C
authors.initials: JC
authors.lastname: Lavoie
authors.forename: D L
authors.initials: DL
authors.lastname: Forrest
authors.forename: M J
authors.initials: MJ
authors.lastname: Barnett
authors.forename: J D
authors.initials: JD
authors.lastname: Shepherd
authors.forename: J Y
authors.initials: JY
authors.lastname: Nitta
authors.forename: S
authors.initials: S
authors.lastname: Wong
authors.forename: H J
authors.initials: HJ
authors.lastname: Sutherland
authors.forename: C A
authors.initials: CA
authors.lastname: Smith
mesh_terms: 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
chemical_list: D000477:Alkylating Agents; D004791:Enzyme Inhibitors; D019653:Myeloablative Agonists; D059005:Topoisomerase II Inhibitors