Pediatric therapy-related myelodysplastic syndrome/acute myeloid leukemia: the MD Anderson Cancer Center experience.
Therapy-related myelodysplastic syndrome/acute myeloid leukemia (t-MDS/AML) is a long-term complication of pediatric cancer. We retrospectively studied pediatric t-MDS/AML patients treated at MD Anderson from 1975 to 2007. We also compared those patients to pediatric patients with de novo MDS/AML during this time interval. Among 2589 children with cancer treated at MD Anderson, we identified 22 patients with t-MDS/AML. Patients with t-MDS/AML had a median age of 14 years. There was a male and Hispanic predominance. The most common primary malignancies were osteosarcoma and Hodgkin lymphoma. The median latency period was 4.1 years. Three patients received supportive care only. Group 1 (n=5) underwent stem cell transplantation without induction chemotherapy. Group 2 (n=5) patients received AML-type chemotherapy and a stem cell transplant postremission (n=5). Group 3 (n=4) received a stem cell transplant as salvage therapy. The respective 2-year survival rates for groups 1, 2, and 3 were 20%, 40%, and 25% (P=0.85). Patients with de novo AML were younger (P=0.001) and higher rates of complete remission (P=0.03), and survival (P<0.0001). Independent factors predicting shorter survival were poor/intermediate-risk cytogenetics (P=0.01), lower hemoglobin level (P=0.0001), and t-MDS/AML (vs. de novo) (P=0.003). Childhood t-MDS/AML has a poor prognosis. Although patients benefited from AML-type induction chemotherapy followed by stem cell transplantation as postremission therapy, effective therapies, and prevention are needed.
Division of Pediatrics, The University of Texas MD Anderson Cancer Center, TX, USA.
Dolly G
DG
Aguilera
Christos
C
Vaklavas
Apostolia M
AM
Tsimberidou
Sijin
S
Wen
L Jeffrey
LJ
Medeiros
Seth J
SJ
Corey
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D008297:Male; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012516:Osteosarcoma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014184:Transplantation, Homologous