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Lymphoma

Therapy-related acute myeloid leukemia and myelodysplastic syndrome after hematopoietic cell transplantation for lymphoma

Bone Marrow Transplantation volume 52, pages 969–976 (2017)Cite this article

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Abstract

Therapy-related acute myeloid leukemia and myelodysplastic syndrome (t-AML/MDS) represent severe late effects in patients receiving hematopoietic cell transplantation (HCT) for lymphoma. The choice between high-dose therapy with autologous HCT and allogeneic HCT with reduced-intensity conditioning remains controversial in patients with relapsed lymphoma. We retrospectively analyzed incidence and risk factors for the development of t-AML/MDS in lymphoma patients treated with autologous or allogeneic HCT. A total of 13 810 lymphoma patients who received autologous (n=9963) or allogeneic (n=3847) HCT between 1985 and 2012 were considered. At a median overall survival (OS) of 52 and 46 months in autologous and allogeneic HCT groups, respectively, lymphoma patients receiving autologous HCT (1.38% at 3 years after autologous HCT) had a significant risk for developing t-AML/MDS compared to allogeneic HCT (0.37% at 3 years after allogeneic HCT, P<0.001). Significant risk factors for the development of t-AML/MDS after autologous and allogeneic HCT were high-stage risk at HCT (P=0.04) or secondary malignancies (P<0.001) and receiving cord blood stem cell (P=0.03) or involved field radiotherapy (P=0.002), respectively. Strategies that carefully select lymphoma patients for autologous HCT, by excluding lymphoma patients with high-stage risk at HCT, may allow the identification of individual lymphoma patients at particular high risk for t-AML/MDS.

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Acknowledgements

We thank the patients and clinical staff for their participation in the study. The authors also thank Yoshinobu Kanda (Jichi Medical University) for helpful discussion, the Japanese Data Center for Hematopoietic Cell Transplantation for data management, and the Clinical Research Institute of Kyushu Medical Hospital for their editorial support. This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED.

Author contributions

SY contributed to the study design, data analysis, and manuscript preparation; KH, KF, HI, SM, YA, TF, NU, HU, HI, AY, KT, HY, JK, HN, YA, K-iM, YN and YA provided clinical data; RS and JS managed clinical data; and all of them reviewed the manuscript.

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Authors and Affiliations

  1. Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    S Yamasaki

  2. Department of Oncology and Haematology, Shimane University Hospital, Izumo, Japan

    R Suzuki & J Suzumiya

  3. Division of Hematology and Cell Therapy, Jichi Medical University, Shimotsuke, Japan

    K Hatano

  4. Division of Hematology, Rinku General Medical Center, Izumisano, Japan

    K Fukushima

  5. Division of Cell Therapy, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

    H Iida

  6. Department of Hematology and Oncology, Fujita Health University School of Medicine, Toyoake, Japan

    S Morishima

  7. Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Y Suehiro

  8. Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    T Fukuda

  9. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    N Uchida

  10. Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    H Uchiyama

  11. Department of Gastroenterology, Rheumatology and Clinical Immunology, Sapporo Medical University Hospital, Sapporo, Japan

    H Ikeda

  12. Department of Hematology, Chiba Aoba Municipal Hospital, Chiba, Japan

    A Yokota

  13. Hematology Division, National Cancer Center Hospital East, Kashiwa, Japan

    K Tsukasaki

  14. Department of Hematology, Nippon Medical School, Tokyo, Japan

    H Yamaguchi

  15. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

    J Kuroda

  16. Department of Hematology, Osaka City University Hospital, Osaka, Japan

    H Nakamae

  17. Department of Internal Medicine, Japan Community Health Care Organization Kobe Central Hospital, Kobe, Japan

    Y Adachi

  18. Division of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    K-i Matsuoka

  19. Third Department of Internal of Medicine, Yamaguchi University School of Medicine, Ube, Japan

    Y Nakamura

  20. Department of Healthcare Administration, Nagoya University Graduate School of Medicine and Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Y Atsuta

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  1. S Yamasaki
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  2. R Suzuki
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  3. K Hatano
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  4. K Fukushima
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  5. H Iida
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  6. S Morishima
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  7. Y Suehiro
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  8. T Fukuda
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  9. N Uchida
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  10. H Uchiyama
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  11. H Ikeda
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  12. A Yokota
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  13. K Tsukasaki
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  14. H Yamaguchi
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  15. J Kuroda
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  16. H Nakamae
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  17. Y Adachi
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  18. K-i Matsuoka
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  19. Y Nakamura
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  20. Y Atsuta
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  21. J Suzumiya
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Corresponding author

Correspondence to S Yamasaki.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Yamasaki, S., Suzuki, R., Hatano, K. et al. Therapy-related acute myeloid leukemia and myelodysplastic syndrome after hematopoietic cell transplantation for lymphoma. Bone Marrow Transplant 52, 969–976 (2017). https://doi.org/10.1038/bmt.2017.52

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