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Acute Leukemia

Outcomes of patients with therapy-related AML/myelodysplastic syndrome (t-AML/MDS) following hematopoietic cell transplantation

Bone Marrow Transplantation volume 50, pages 1180–1186 (2015)Cite this article

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Abstract

We studied outcomes of 65 consecutive patients with therapy-related AML/myelodyplastic syndrome (t-AML/MDS) who underwent allogeneic hematopoietic cell transplantation (HCT). Previously published scores of HCT-CI, CIBMTR, EBMT and Comorbidity-age index were also evaluated. Median follow-up of survivors was 72 months (range 16–204). At 2 years, overall survival (OS) was 34% (95% confidence interval (CI) 23–45). Nineteen patients (29%) had monosomal karyotype (MK). Patients with MK had an OS of 21% (95% CI 7–41) at 2 years. Abnormal adverse cytogenetics, unrelated donor, bone marrow graft and CIBMTR score were significant risk factors for OS on univariate analysis. On multivariate analysis, abnormal adverse cytogenetics (hazard ratio (HR) 2.7; 95% CI 1.02–7.2; P-value=0.02) and unrelated donor (HR 2.7; 95% CI 1.5–5.0; P-value=0.0013) were independent factors for survival. Non-relapse mortality (NRM) at 2 years was 31% (95% CI 15–47). Donor type was the only factor that was significant for NRM with matched related donors having an NRM of 20% (95% CI 0–42) whereas unrelated donors had NRM of 60% (95% CI 40–80; P-value=0.0007). In conclusion, patients with t-AML/MDS have poor OS. Unrelated donor is a significant risk factor for both higher NRM and decreased OS. Cytogenetics are predictive for OS.

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Authors and Affiliations

  1. Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada,

    N Alam, J Kuruvilla, J Uhm, J H Lipton, H A Messner, D H Kim, M Seftel & V Gupta

  2. Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada

    E G Atenafu

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  1. N Alam
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Correspondence to N Alam.

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Author contributions

NA and VG contributed to the design of study, the supervision of data collection and of data interpretation, data analysis, and writing the manuscript. EGA prepared statistical plan, performed statistical analysis and interpreted results. DK, JU, HAM, JK, JHL and MS were involved in the supervision of the data collection and interpretation of the data. All authors critically reviewed and approved the final draft of the manuscript.

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Alam, N., Atenafu, E., Kuruvilla, J. et al. Outcomes of patients with therapy-related AML/myelodysplastic syndrome (t-AML/MDS) following hematopoietic cell transplantation. Bone Marrow Transplant 50, 1180–1186 (2015). https://doi.org/10.1038/bmt.2015.151

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