title: Secondary myeloid neoplasms: bone marrow cytogenetic and histological features may be relevant to prognosis.
abstract: BACKGROUND
  Secondary myeloid neoplasms comprise a group of diseases arising after chemotherapy, radiation, immunosuppressive therapy or from aplastic anemia. Few studies have addressed prognostic factors in these neoplasms.
  
  
  METHODS
  Forty-two patients diagnosed from 1987 to 2008 with secondary myeloid neoplasms were retrospectively evaluated concerning clinical, biochemical, peripheral blood, bone marrow aspirate, biopsy, and immunohistochemistry and cytogenetic features at diagnosis as prognostic factors. The International Prognostic Scoring System was applied. Statistical analysis employed the Kaplan-Meier method, log-rank and Fisher's exact test.
  
  
  RESULTS
  Twenty-three patients (54.8%) were male and the median age was 53.5 years (range: 4-88 years) at diagnosis of secondary myeloid neoplasms. Previous diseases included hematologic malignancies, solid tumors, aplastic anemia, autoimmune diseases and conditions requiring solid organ transplantations. One third of patients (33%) were submitted to chemotherapy alone, 2% to radiotherapy, 26% to both modalities and 28% to immunosuppressive agents. Five patients (11.9%) had undergone autologous hematopoietic stem cell transplantation. The median latency between the primary disease and secondary myeloid neoplasms was 85 months (range: 23-221 months). Eight patients were submitted to allogeneic hematopoietic stem cell transplantation to treat secondary myeloid neoplasms. Important changes in bone marrow were detected mainly by biopsy, immunohistochemistry and cytogenetics. The presence of clusters of CD117+cells and p53+cells were associated with low survival. p53 was associated to a higher risk according to the International Prognostic Scoring System. High prevalence of clonal abnormalities (84.3%) and thrombocytopenia (78.6%) were independent factors for poor survival.
  
  
  CONCLUSIONS
  This study demonstrated that cytogenetics, bone marrow biopsy and immunohistochemistry are very important prognostic tools in secondary myeloid neoplasms.
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil. Electronic address: robertatani@uol.com.br.
authors.forename: Roberta Sandra da Silva
authors.initials: RS
authors.lastname: Tanizawa
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil.
authors.forename: Maria Claudia Nogueira
authors.initials: MC
authors.lastname: Zerbini
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), Hospital São Paulo, São Paulo, SP, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rosenfeld
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil.
authors.forename: Cristina Aiko
authors.initials: CA
authors.lastname: Kumeda
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil.
authors.forename: Raymundo Soares
authors.initials: RS
authors.lastname: Azevedo
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil.
authors.forename: Sheila Aparecida Coelho
authors.initials: SA
authors.lastname: Siqueira
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil.
authors.forename: Elvira Deolinda Rodrigues Pereira
authors.initials: ED
authors.lastname: Velloso
keywords: Myelodysplastic syndromes; Second malignancy; Second neoplasm; Secondary effect; Therapy-associated neoplasm ;