This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kalaycio, M. Articles by Bolwell, B. Search for Related Content PubMed PubMed Citation Articles by Kalaycio, M. Articles by Bolwell, B. Social Bookmarking                            What's this?

Risk Factors Before Autologous Stem-Cell Transplantation for Lymphoma Predict for Secondary Myelodysplasia and Acute Myelogenous Leukemia

Matt Kalaycio, Lisa Rybicki, Brad Pohlman, Ronald Sobecks, Steven Andresen, Elizabeth Kuczkowski, Brian Bolwell

From the Departments of Hematology and Medical Oncology and Quantitative Health Sciences, The Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, OH

Address reprint requests to Matt Kalaycio, MD, 9500 Euclid Ave/R35, Cleveland, OH 44195; e-mail: kalaycm{at}ccf.org

PURPOSE: The risk factors for treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (AML) after autologous stem-cell transplantation (ASCT) are similar to those that increase the risk of difficult stem-cell harvests. We reviewed our experience in 526 patients with lymphoma treated by ASCT to determine whether difficult stem-cell harvests predict for an increased risk of t-MDS/AML.

PATIENTS AND METHODS: Autologous peripheral stem cells were initially mobilized with granulocyte colony-stimulating factor (G-CSF; or granulocyte-macrophage colony-stimulating factor) alone (n = 334), etoposide and G-CSF (n = 166), or cyclophosphamide and G-CSF with or without etoposide (n = 26). Difficult harvests were those that required more than 5 days to collect enough stem cells and those that required additional attempts with etoposide and/or cyclophosphamide plus G-CSF (n = 52). All patients were then treated with high-dose chemotherapy alone and observed for outcome.

RESULTS: With a median follow-up time for surviving patients of 69 months, 20 patients developed t-MDS/AML, for an actuarial incidence of 6.8% at 10 years. Pretransplantation characteristics, including age, diagnosis of non-Hodgkin's lymphoma or Hodgkin's disease, bone marrow involvement, prior radiation therapy, prior exposure to chemotherapy, lactate dehydrogenase at the time of ASCT, disease status, and method of stem-cell mobilization, were then analyzed with respect to the subsequent development of t-MDS/AML. By multivariable analysis, prior exposure to radiation therapy, four or more chemotherapy regimens, and more than 5 days of apheresis needed to harvest enough stem cells were identified as independent risk factors for t-MDS/AML. Bootstrap analysis confirmed these results.

CONCLUSION: These results suggest that identifiable pretransplantation factors predict for t-MDS/AML after ASCT.

Presented in part at the 45th Annual Meeting of the American Society of Hematology, San Diego, CA, December 6-9, 2003.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Chakraborty, C.-L. Sun, L. Francisco, M. Sabado, L. Li, K. L. Chang, S. Forman, S. Bhatia, and R. Bhatia Accelerated Telomere Shortening Precedes Development of Therapy-Related Myelodysplasia or Acute Myelogenous Leukemia After Autologous Transplantation for Lymphoma J. Clin. Oncol., February 10, 2009; 27(5): 791 - 798. [Abstract] [Full Text] [PDF]

				B. S. Hoppe, C. H. Moskowitz, D. A. Filippa, C. S. Moskowitz, T. Kewalramani, A. D. Zelenetz, and J. Yahalom Involved-Field Radiotherapy Before High-Dose Therapy and Autologous Stem-Cell Rescue in Diffuse Large-Cell Lymphoma: Long-Term Disease Control and Toxicity J. Clin. Oncol., April 10, 2008; 26(11): 1858 - 1864. [Abstract] [Full Text] [PDF]

				A. K. Gopal, J. G. Rajendran, T. A. Gooley, J. M. Pagel, D. R. Fisher, S. H. Petersdorf, D. G. Maloney, J. F. Eary, F. R. Appelbaum, and O. W. Press High-Dose [131I]Tositumomab (anti-CD20) Radioimmunotherapy and Autologous Hematopoietic Stem-Cell Transplantation for Adults >= 60 Years Old With Relapsed or Refractory B-Cell Lymphoma J. Clin. Oncol., April 10, 2007; 25(11): 1396 - 1402. [Abstract] [Full Text] [PDF]