Published online 10 March 2009
Haematologica, Vol 94, Issue 4, 542-549 doi:10.3324/haematol.2008.000927
Copyright © 2009 by Ferrata Storti Foundation

This Article Full Text Full Text (PDF) Kroger et al. - Supplementary Appendix Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kröger, N. Search for Related Content PubMed PubMed Citation Articles by Kröger, N. Related Collections Related Article

Stem Cell Transplantation

Risk factors for therapy-related myelodysplastic syndrome and acute myeloid leukemia treated with allogeneic stem cell transplantation

Nicolaus Kröger¹, Ronald Brand², Anja van Biezen², Axel Zander¹, Judith Dierlamm³, Dietger Niederwieser⁴, Agnès Devergie⁵, Tapani Ruutu⁶, Jackie Cornish⁷, Per Ljungman⁸, Alois Gratwohl⁹, Catherine Cordonnier¹⁰, Dietrich Beelen¹¹, Eric Deconinck¹², Argiris Symeonidis¹³, Theo de Witte¹⁴, for the Myelodysplastic Syndromes Subcommittee of The Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT)

¹ Dept. for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Germany
² Dept. of Medical Statistics, Leiden University, Leiden, The Netherlands
³ Dept. of Haematology and Oncology, University Hospital Hamburg-Eppendorf, Germany
⁴ Dept. of Haematology and Oncology, University of Leipzig, Germany
⁵ Dept. of Hematology, BMT, Hôpital St. Louis, Paris, France
⁶ Dept. of Medicine, Helsinki University Central Hospital, Helsinki, Finland
⁷ Dept. of Paediatric Oncology/BMT, Bristol Royal Hospital for Children, Bristol, United Kingdom
⁸ Dept. of Hematology, Huddinge University Hospital, Huddinge, Sweden
⁹ Dept. of Hematology, University Hospital, Basel, Switzerland
¹⁰ Dept. of Hematology, Henri Mondor Teaching Hospital, Creteil, France
¹¹ Dept. of Bone Marrow Transplantation, University Hospital, Essen, Germany
¹² Dept. of Hematology, Hôpital Jean Minjoz, Besancon, France
¹³ Dept of Hematology, University of Patras, Patras, Greece
¹⁴ Dept. of Hematology, University Medical Center St. Radboud, Nijmegen, The Netherlands

Correspondence: Nicolaus Kröger, Dept. for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. E-mail:nkroeger{at}uke.uni-hamburg.de

Background: After successful treatment of malignant diseases, therapy-related myelodysplastic syndrome and acute myeloid leukemia have emerged as significant problems.

Design and Methods: The aim of this study was to investigate outcome and risk factors in patients with therapy-related myelodysplastic syndrome or acute myeloid leukemia who underwent allogeneic stem cell transplantation. Between 1981 and 2006, 461 patients with therapy-related myelodysplastic syndrome or acute myeloid, a median age of 40 years and a history of solid tumor (n=163), malignant lymphoma (n=133), or other hematologic diseases (n=57) underwent stem cell transplantation and their data were reported to the European Group for Blood and Marrow Transplantation.

Results: The cumulative incidence of non-relapse mortality and relapse at 3 years was 37% and 31%, respectively. In a multivariate analysis significant factors for relapse were not being in complete remission at the time of transplantation (p=0.002), abnormal cytogenetics (p=0.005), higher patients’ age (p=0.03) and therapy-related myelodysplastic syndrome (p=0.04), while higher non-relapse mortality was influenced by higher patients’ age. Furthermore, there was a marked reduction in non-relapse mortality per calendar year during the study period (p<0.001). The 3-year relapse-free and overall survival rates were 33% and 35%, respectively. In a multivariate analysis significant higher overall survival rates were seen per calendar year (p<0.001), for younger age (<40 years) and normal cytogenetics (p=0.05). Using age (<40 years), abnormal cytogenetics and not being in complete remission at the time of transplantation as risk factors, three different risk groups with overall survival rates of 62%, 33% and 24% could be easily distinguished.

Conclusions: Allogeneic stem cell transplantation can cure patients with therapy-related myelodysplastic syndrome and acute myeloid leukemia and has markedly improved over time. Non-complete remission, abnormal cytogenetics and higher patients’ age are the most significant factors predicting survival.

Key words: allogeneic stem cell transplantation, therapy-related, myelodysplastic syndrome, acute myelogenous leukemia, cytogenetic abnormalities.

Related Article

Therapy-related myeloid neoplasms

Richard A. Larson
Haematologica 2009 94: 454-459. [Full Text] [PDF]

This article has been cited by other articles:

				R. A. Larson Therapy-related myeloid neoplasms Haematologica, April 1, 2009; 94(4): 454 - 459. [Full Text] [PDF]