Blood Journal
Leading the way in experimental and clinical research in hematology

Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia

  1. Mark R. Litzow1,
  2. Sergey Tarima2,
  3. Waleska S. Pérez3,
  4. Brian J. Bolwell4,
  5. Mitchell S. Cairo5,
  6. Bruce M. Camitta6,
  7. Corey S. Cutler7,
  8. Marcos de Lima8,
  9. John F. DiPersio9,
  10. Robert Peter Gale10,
  11. Armand Keating11,
  12. Hillard M. Lazarus12,
  13. Selina Luger13,
  14. David I. Marks14,
  15. Richard T. Maziarz15,
  16. Philip L. McCarthy16,
  17. Marcelo C. Pasquini3,
  18. Gordon L. Phillips17,
  19. J. Douglas Rizzo3,
  20. Jorge Sierra18,
  21. Martin S. Tallman19, and
  22. Daniel J. Weisdorf20
  1. 1Mayo Clinic Rochester, Rochester, MN;
  2. 2Medical College of Wisconsin, Milwaukee;
  3. 3Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee;
  4. 4Cleveland Clinic Foundation, OH;
  5. 5Morgan Stanley Children's Hospital NY-Presbyterian, New York City;
  6. 6Children's Hospital of Wisconsin, Milwaukee;
  7. 7Dana-Farber Cancer Institute, Boston, MA;
  8. 8M. D. Anderson Cancer Center, Houston, TX;
  9. 9St Louis Children's Hospital, MO;
  10. 10Celgene Corporation, Summit, NJ;
  11. 11Princess Margaret Hospital, Toronto, ON;
  12. 12University Hospital Case Medical Center, Cleveland, OH;
  13. 13Hospital of the University of Pennsylvania, Philadelphia;
  14. 14United Bristol Healthcare, Bristol, United Kingdom;
  15. 15Oregon Health & Science University, Portland;
  16. 16Roswell Park Cancer Institute, Buffalo, NY;
  17. 17University of Rochester Medical Center, NY;
  18. 18Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
  19. 19Northwestern Memorial Hospital, Chicago, IL; and
  20. 20University of Minnesota Medical Center, Minneapolis

Abstract

Therapy-related myelodysplastic syndromes (t-MDSs) and acute myeloid leukemia (t-AML) have a poor prognosis with conventional therapy. Encouraging results are reported after allogeneic transplantation. We analyzed outcomes in 868 persons with t-AML (n = 545) or t-MDS (n = 323) receiving allogeneic transplants from 1990 to 2004. A myeloablative regimen was used for conditioning in 77%. Treatment-related mortality (TRM) and relapse were 41% (95% confidence interval [CI], 38-44) and 27% (24-30) at 1 year and 48% (44-51) and 31% (28-34) at 5 years, respectively. Disease-free (DFS) and overall survival (OS) were 32% (95% CI, 29-36) and 37% (34-41) at 1 year and 21% (18-24) and 22% (19-26) at 5 years, respectively. In multivariate analysis, 4 risk factors had adverse impacts on DFS and OS: (1) age older than 35 years; (2) poor-risk cytogenetics; (3) t-AML not in remission or advanced t-MDS; and (4) donor other than an HLA-identical sibling or a partially or well-matched unrelated donor. Five-year survival for subjects with none, 1, 2, 3, or 4 of these risk factors was 50% (95% CI, 38-61), 26% (20-31), 21% (16-26), 10% (5-15), and 4% (0-16), respectively (P < .001). These data permit a more precise prediction of outcome and identify subjects most likely to benefit from allogeneic transplantation.

  • Submitted October 13, 2009.
  • Accepted November 26, 2009.
View Full Text