title: Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell transplantation.
abstract: BACKGROUND
  After successful treatment of malignant diseases, therapy-related myelodysplastic syndrome and acute myeloid leukemia have emerged as significant problems.
  
  
  METHODS
  The aim of this study was to investigate outcome and risk factors in patients with therapy-related myelodysplastic syndrome or acute myeloid leukemia who underwent allogeneic stem cell transplantation. Between 1981 and 2006, 461 patients with therapy-related myelodysplastic syndrome or acute myeloid, a median age of 40 years and a history of solid tumor (n=163), malignant lymphoma (n=133), or other hematologic diseases (n=57) underwent stem cell transplantation and their data were reported to the European Group for Blood and Marrow Transplantation.
  
  
  RESULTS
  The cumulative incidence of non-relapse mortality and relapse at 3 years was 37% and 31%, respectively. In a multivariate analysis significant factors for relapse were not being in complete remission at the time of transplantation (p=0.002), abnormal cytogenetics (p=0.005), higher patients' age (p=0.03) and therapy-related myelodysplastic syndrome (p=0.04), while higher non-relapse mortality was influenced by higher patients' age. Furthermore, there was a marked reduction in non-relapse mortality per calendar year during the study period (p<0.001). The 3-year relapse-free and overall survival rates were 33% and 35%, respectively. In a multivariate analysis significant higher overall survival rates were seen per calendar year (p<0.001), for younger age (<40 years) and normal cytogenetics (p=0.05). Using age (<40 years), abnormal cytogenetics and not being in complete remission at the time of transplantation as risk factors, three different risk groups with overall survival rates of 62%, 33% and 24% could be easily distinguished.
  
  
  CONCLUSIONS
  Allogeneic stem cell transplantation can cure patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia and has markedly improved over time. Non-complete remission, abnormal cytogenetics and higher patients' age are the most significant factors predicting survival.
authors.affiliation: Dept. for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. nkroeger@uke.uni-hamburg.de
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: Anja
authors.initials: A
authors.lastname: van Biezen
authors.forename: Axel
authors.initials: A
authors.lastname: Zander
authors.forename: Judith
authors.initials: J
authors.lastname: Dierlamm
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Agnès
authors.initials: A
authors.lastname: Devergie
authors.forename: Tapani
authors.initials: T
authors.lastname: Ruutu
authors.forename: Jackie
authors.initials: J
authors.lastname: Cornish
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Argiris
authors.initials: A
authors.lastname: Symeonidis
authors.forename: Theo
authors.initials: T
authors.lastname: de Witte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult