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Second Malignancies

Secondary myelodysplastic syndrome and acute myelogenous leukemia are significant complications following autologous stem cell transplantation for lymphoma

Bone Marrow Transplantation volume 32, pages 317–324 (2003)Cite this article

Summary:

Secondary myelodysplastic syndrome (sMDS) and acute myelogenous leukemia (AML) have been recognized with increasing frequency following autologous stem cell transplantation (ASCT). A retrospective analysis of 230 consecutive patients with Hodgkin's lymphoma (HL, 64) and non-Hodgkin's lymphoma (NHL, 166) who underwent ASCT was conducted to assess the incidence and risk factors for the development of sMDS/AML. At a median follow up of 41 months (range 0.1–177 months), 10 of 230 patients (4.3%) developed sMDS/AML. The 5-year-actuarial incidence of sMDS/AML was 13.1% and 5-year cumulative incidence by competing risk analysis was 4.2%. The median time to development of sMDS/AML was 39.9 months from the time of ASCT (range 12.1–62.0 months). Complex karyotypes at diagnosis of sMDS/AML included structural anomalies and/or loss of chromosome 5 (eight patients), 7 (five patients), 17 (two patients) and 20 (two patients). All patients subsequently died, at a median of 6.8 months (range 0–39.9) from diagnosis of sMDS/AML. Fluorescent in situ hybridization (FISH) analysis for −5/5q- and −7/7q- were normal in all six patients whose pre-ASCT bone marrow was available for testing. Five of the six had samples available for testing at diagnosis of sMDS/AML and all had abnormal FISH results. By univariate statistical analysis, male gender (P=0.01), prior alkylating agents (mechlorethamine for HL, P=0.001 and cyclophosphamide for NHL, P=0.05) and the number of prior treatment regimens (P=0.04) were significantly associated with the development of sMDS/AML. Given the relatively low incidence rate of sMDS/AML, these analyses are primarily exploratory in nature but provide some insight into relevant risk factors and illustrate the risk of developing sMDS/AML after myeloablative conditioning and ASCT for lymphoma.

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Acknowledgements

We thank Nathan Foster for help with the statistical analysis, Stephanie Brockman for the FISH analysis and Alisa Marxhausen for secretarial assistance.

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Authors and Affiliations

  1. Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA

    R Howe

  2. Division of Hematology, Blood and Marrow Transplantation, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA

    I N M Micallef, D J Inwards, S M Ansell, A Dispenzieri, D A Gastineau, M A Gertz, M Q Lacy, A Tefferi & M R Litzow

  3. Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA

    G W Dewald & C A Hanson

  4. Department of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA

    S M Geyer

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Howe, R., Micallef, I., Inwards, D. et al. Secondary myelodysplastic syndrome and acute myelogenous leukemia are significant complications following autologous stem cell transplantation for lymphoma. Bone Marrow Transplant 32, 317–324 (2003). https://doi.org/10.1038/sj.bmt.1704124

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