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Allografting

Predictors of outcome following myeloablative allo-SCT for therapy-related myelodysplastic syndrome and AML

Bone Marrow Transplantation volume 42, pages 659–666 (2008)Cite this article

Abstract

Administration of alkylating agents (Alk), topoisomerase II inhibitors (Topo II) and radiotherapy (RT) can result in therapy-related myelodysplastic syndrome or acute myelogenous leukaemia (t-MDS/t-AML), the optimal treatment for which is allo-SCT. A retrospective review was performed of 24 patients who underwent related- or unrelated-donor SCT for t-MDS/t-AML at our institution. Eight patients remain alive and in continuous remission (median follow-up 54 months (range, 12–161)) with estimated 5-year EFS being 30% (95% confidence intervals 16–58%). Corresponding actuarial risks of relapse and non-relapse mortality (NRM) are 39% (19–60%) and 30% (13–50%), respectively. EFS was 40% in Alk/RT-related t-MDS/t-AML and 11% in Topo II-related t-MDS/t-AML (P=0.05), with an increased risk of relapse in the latter (56 vs 29%, respectively (P=0.05)). In multivariate analysis, development of acute GVHD (P=0.009) and Topo II-related t-MDS/t-AML (P=0.018) were associated with inferior EFS. Patients with acute GVHD had an increased risk of NRM (P=0.03) whereas risk of relapse was higher for patients of advanced age (P=0.046) and for patients who underwent bone marrow (vs blood) SCT (P=0.032). Allo-SCT can result in long-term survival for individuals with t-MDS/t-AML although outcome in Topo II-related t-MDS/t-AML patients remains suboptimal.

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Acknowledgements

We thank the nursing and support staff of Wards T15 and CP6 of the Vancouver General Hospital for the superb care given to the patients of the Leukaemia/BMT Program of British Columbia and Alan Le and Yung-Feng Dai for their assistance with the graphics in the paper.

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Authors and Affiliations

  1. Division of Hematology, The Leukaemia Bone Marrow Transplantation Program of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada

    T J Nevill, D E Hogge, C L Toze, S H Nantel, M M Power, Y R Abou Mourad, K W Song, J C Lavoie, D L Forrest, M J Barnett, J D Shepherd, H J Sutherland & C A Smith

  2. BC Cancer Agency, Vancouver, British Columbia, Canada

    T J Nevill, D E Hogge, C L Toze, S H Nantel, M M Power, Y R Abou Mourad, K W Song, J C Lavoie, D L Forrest, M J Barnett, J D Shepherd, J Y Nitta, S Wong, H J Sutherland & C A Smith

  3. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    T J Nevill, D E Hogge, C L Toze, S H Nantel, M M Power, Y R Abou Mourad, K W Song, J C Lavoie, D L Forrest, M J Barnett, J D Shepherd, H J Sutherland & C A Smith

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Correspondence to T J Nevill.

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Nevill, T., Hogge, D., Toze, C. et al. Predictors of outcome following myeloablative allo-SCT for therapy-related myelodysplastic syndrome and AML. Bone Marrow Transplant 42, 659–666 (2008). https://doi.org/10.1038/bmt.2008.226

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