Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia.
Therapy-related myelodysplastic syndromes (t-MDSs) and acute myeloid leukemia (t-AML) have a poor prognosis with conventional therapy. Encouraging results are reported after allogeneic transplantation. We analyzed outcomes in 868 persons with t-AML (n = 545) or t-MDS (n = 323) receiving allogeneic transplants from 1990 to 2004. A myeloablative regimen was used for conditioning in 77%. Treatment-related mortality (TRM) and relapse were 41% (95% confidence interval [CI], 38-44) and 27% (24-30) at 1 year and 48% (44-51) and 31% (28-34) at 5 years, respectively. Disease-free (DFS) and overall survival (OS) were 32% (95% CI, 29-36) and 37% (34-41) at 1 year and 21% (18-24) and 22% (19-26) at 5 years, respectively. In multivariate analysis, 4 risk factors had adverse impacts on DFS and OS: (1) age older than 35 years; (2) poor-risk cytogenetics; (3) t-AML not in remission or advanced t-MDS; and (4) donor other than an HLA-identical sibling or a partially or well-matched unrelated donor. Five-year survival for subjects with none, 1, 2, 3, or 4 of these risk factors was 50% (95% CI, 38-61), 26% (20-31), 21% (16-26), 10% (5-15), and 4% (0-16), respectively (P < .001). These data permit a more precise prediction of outcome and identify subjects most likely to benefit from allogeneic transplantation.
Litzow
Mark R
MR
Mayo Clinic Rochester, Rochester, MN, USA.
Tarima
Sergey
S
Pérez
Waleska S
WS
Bolwell
Brian J
BJ
Cairo
Mitchell S
MS
Camitta
Bruce M
BM
Cutler
Corey S
CS
de Lima
Marcos
M
Dipersio
John F
JF
Gale
Robert Peter
RP
Keating
Armand
A
Lazarus
Hillard M
HM
Luger
Selina
S
Marks
David I
DI
Maziarz
Richard T
RT
McCarthy
Philip L
PL
Pasquini
Marcelo C
MC
Phillips
Gordon L
GL
Rizzo
J Douglas
JD
Sierra
Jorge
J
Tallman
Martin S
MS
Weisdorf
Daniel J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult