Therapy-related MDS/AML after autologous stem cell transplantation for lymphoma with BEAM as conditioning: our experience

Czech version

Authors: P. Bělohlávková; A. Zavřelová; P. Žák; M. Cermanová; D. Belada; J. Voglová; L. Jebavý; J. Malý
Authors‘ workplace: II. interní klinika, oddělení klinické hematologie, Fakultní nemocnice a Lékařská fakulta v Hradci Králové
Published in: Transfuze Hematol. dnes,14, 2008, No. 1, p. 19-23.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Autologous stem cell transplantation (ASCT) is an important therapy for patients with Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). Some reports in long-term survivors document the higher risk of secondary malignancies including myelodysplastic syndrome and acute leukemia. The incidence of therapy related myelodysplastic syndrome and acute leukemia (tMDS/AML) was reported from 2% to 12%. We analyzed group of patients with lymphoma who underwent ASCT with BEAM as conditioning between 1998–2005 with minimal follow up 6 months. Population studied consists of 112 patients (54 males, 58 females), 32 of them presented with HL and 80 with NHL. The median follow up after ASCT was 41 months (range 6–99 months), the median diagnosis to transplantation interval was 24 months (range 4–204 months) and the median age at transplantation was 43 years (range 18–69 years). The history of bone marrow involvement was documented in 26 patients (23%). All our patients received BEAM as the conditioning regimen and then peripheral blood stem cells as a graft. The therapy related MDS/AML occurred in 3 patients (2,5%) with the median time from transplantation to diagnosis tMDS/AML 24 months (range 14–61 months). The median age at transplantation in those patients was 56 years (range 53–57 years). In one case tMDS developed after radioimunochemotherapy for relapsing NHL. In two cases we diagnosed MDS type RCMD (refractory cytopenia with multilineage dysplasia) according to WHO classification and in the third case we diagnosed secondary acute myeloid leukemia with maturation (type M2 according FAB classification). In our single center retrospective analysis we detected low incidence of tMDS/AML after ASCT with BEAM as the conditioning regimen. The crude incidence was 2,5% and 5-year cumulative incidence was 3%.

Key words:
myelodysplastic syndrome, secondary leukemia, autologous stem cell transplantation

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Transfusion and Haematology Today

2008 Issue 1