title: Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia.
abstract: 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.
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Sergey
authors.initials: S
authors.lastname: Tarima
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Camitta
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: John F
authors.initials: JF
authors.lastname: Dipersio
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Armand
authors.initials: A
authors.lastname: Keating
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Selina
authors.initials: S
authors.lastname: Luger
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Phillips
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
mesh_terms: 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