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

Mark R. Litzow, Sergey Tarima, Waleska S. Pérez, Brian J. Bolwell, Mitchell S. Cairo, Bruce M. Camitta, Corey S. Cutler, Marcos de Lima, John F. DiPersio, Robert Peter Gale, Armand Keating, Hillard M. Lazarus, Selina Luger, David I. Marks, Richard T. Maziarz, Philip L. McCarthy, Marcelo C. Pasquini, Gordon L. Phillips, J. Douglas Rizzo, Jorge Sierra, Martin S. Tallman and Daniel J. Weisdorf


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