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Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma.

ABSTRACT: BACKGROUND:Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). METHODS:9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n?=?916), non-Hodgkin lymphoma (NHL; n?=?3546) and plasma cell myeloma (PCM; n?=?4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS. RESULTS:335 MDS/AML cases were diagnosed posttransplant (3.7%). Variables associated with an increased risk for AML or MDS in multivariate analyses were: (1) conditioning with total body radiation versus chemotherapy alone for HL (HR?=?4.0; 95% confidence interval [1.4, 11.6]) and NHL (HR?=?2.5 [1.1, 2.5]); (2) ?3 versus 1 line of chemotherapy for NHL (HR?=?1.9 [1.3, 2.8]); and (3) subjects with NHL transplanted in 2005-2010 versus 1995-1999 (HR?=?2.1 [1.5, 3.1]). Using Surveillance, Epidemiology and End Results (SEER) data, we found risks for AML/MDS in HL, NHL and PCM to be 5-10 times the background rate. In contrast, relative risks were 10-50 for AML and approximately 100 for MDS in the autotransplant cohort. CONCLUSIONS:There are substantial risks of AML and MDS after autotransplants for HL, NHL and PCM.

SUBMITTER: Radivoyevitch T

PROVIDER: S-EPMC6219911 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma.

Radivoyevitch Tomas T Dean Robert M RM Shaw Bronwen E BE Brazauskas Ruta R Tecca Heather R HR Molenaar Remco J RJ Battiwalla Minoo M Savani Bipin N BN Flowers Mary E D MED Cooke Kenneth R KR Hamilton Betty K BK Kalaycio Matt M Maciejewski Jaroslaw P JP Ahmed Ibrahim I Akpek Görgün G Bajel Ashish A Buchbinder David D Cahn Jean-Yves JY D'Souza Anita A Daly Andrew A DeFilipp Zachariah Z Ganguly Siddhartha S Hamadani Mehdi M Hayashi Robert J RJ Hematti Peiman P Inamoto Yoshihiro Y Khera Nandita N Kindwall-Keller Tamila T Landau Heather H Lazarus Hillard H Majhail Navneet S NS Marks David I DI Olsson Richard F RF Seo Sachiko S Steinberg Amir A William Basem M BM Wirk Baldeep B Yared Jean A JA Aljurf Mahmoud M Abidi Muneer H MH Allewelt Heather H Beitinjaneh Amer A Cook Rachel R Cornell Robert F RF Fay Joseph W JW Hale Gregory G Chakrabarty Jennifer Holter JH Jodele Sonata S Kasow Kimberly A KA Mahindra Anuj A Malone Adriana K AK Popat Uday U Rizzo J Douglas JD Schouten Harry C HC Warwick Anne B AB Wood William A WA Sekeres Mikkael A MA Litzow Mark R MR Gale Robert P RP Hashmi Shahrukh K SK

Leukemia research 20180719

<h4>Background</h4>Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).<h4>Methods</h4>9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n = 916), non-Hodgkin lymphoma (NHL; n = 3546) and plasma cell myeloma (PCM; n = 4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS.<h4>Results</h4>335 MDS/AML cases were diagnosed posttransplant (3.7%). Var ...[more]

PMID: 30055822

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Project description:BackgroundAfter successful treatment of malignant diseases, therapy-related myelodysplastic syndrome and acute myeloid leukemia have emerged as significant problems.Design and methodsThe 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.ResultsThe 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.ConclusionsAllogeneic 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.

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Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma.

Publications

Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma.

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