Risk of MDS and AML after autologous stem cell transplantation—results from the literature
| Authors/year/ institution . | Primary tumor . | No. t-MDS/ No. t-AML/ No. treated . | Actuarial risk/relative risk (RR) . | Risk factors and remarks . |
|---|---|---|---|---|
| Miller et al 19948 Minnesota | Hodgkin Non-Hodgkin | 3/0/68 3/1/138 | 14.5%/4 y | PBSC/BMSC 31% vs. 10.5%;P = .0035 |
| Bhatia et al 19969 (follow-up) | Hodgkin Non-Hodgkin | 9/1/258 | 13.5%/6 y | PBSC/BMSC; P = .004 Age >35 y;P = .07 |
| Traweek et al 199410 City of Hope | Hodgkin Non-Hodgkin | 2/2/108 5/1/167 | 9%/3 y | 5 patients with chromosome aberration: no signs of MDS |
| Krishnan et al 199811 (follow-up) | Hodgkin Non-Hodgkin | 24/612* | 9.4%/9 y | PBSC/BMSC; P = .05 Topo II inhibitors—11q23/21q22 translocations |
| Darrington et al 199412 Nebraska | Hodgkin Non-Hodgkin | 4/2/249 6/0/262 | 4%/5 y | Age ≥40 y; P = .05 TBI; P = .06 |
| Stone et al 199413 Dana Farber | Non-Hodgkin | 18/2/262 | 18%/6 y | Prolonged interval diagnosis to ASCT; P = .003 Duration of prior CT; P = .019 Radiation therapy; P = .032 Pelvic irradiation; P = .003 Age >38 y with low platelet counts |
| Friedberg et al 199914 (follow-up) | Non-Hodgkin | 41/0/552 | 19.8%/10 y | Fewer no. of cells reinfused;P = .0003 |
| Wheeler et al 199715 Dana Farber | Hodgkin Non-Hodgkin | 6/300* | 4.2%/5 y | Prior relapses; P = .009 Prior radiotherapy; P = .05 |
| Taylor et al 199716 Newcastle | Hodgkin Non-Hodgkin | 0/1/52 0/0/62 | 1.1%/20 mo (+1 CML) | 60% transplant. in 1. CR |
| Pedersen-Bjergaard et al 199717 Copenhagen | Hodgkin Non-Hodgkin | 1/1/27 3/1/49 | 24.3%/43 mo RR = 357 | Antecedent CT risk factor |
| André et al 199818 French Cooperative | Hodgkin | 5/3/467 | 4.3%/5 y | Splenectomy;P = .067 PBSC/BMSC;P = .077 |
| Harrison et al 199919British Cooperative | Hodgkin | 8/595* | 3.1%/5 y | Quantity of prior therapy; P < .0001 MOPP; P = .0009 Lomustine;P = .001 Transplant. versus non-transplant; P = .25 |
| Milligan et al 199920 EMBT Cooperative | Hodgkin Non-Hodgkin | 51/15/4998 | 4.6%/5 y 3.0%/5 y | Age at transplantation; P < .001 TBI at conditioning; P < .001 Number of transplants; P < .002 Years from diagnosis to transplantation;P < .001 |
| Govindarajan et al 199621Little Rock, Arkansas | Multiple myeloma (tandem-transpl.) | 0/0/71† 7/0/117‡ | 0% 12%/4 y | ASCT in 1. CR versus ASCT in multitreated P = .02 |
| Laughlin et al 199822 Duke University | Breast cancer | 3/2/8641-153 | 1.6%/4 y | — |
| Kollmannsberger et al 199823 German/French Cooperative | Germ cell tumors (advanced stage) | 2/4/302 | 1.3%/52 mo1-155 RR: 160 | Previously etoposide >2.4 g/m2 + Cis + Ifos/Ctx |
| Authors/year/ institution . | Primary tumor . | No. t-MDS/ No. t-AML/ No. treated . | Actuarial risk/relative risk (RR) . | Risk factors and remarks . |
|---|---|---|---|---|
| Miller et al 19948 Minnesota | Hodgkin Non-Hodgkin | 3/0/68 3/1/138 | 14.5%/4 y | PBSC/BMSC 31% vs. 10.5%;P = .0035 |
| Bhatia et al 19969 (follow-up) | Hodgkin Non-Hodgkin | 9/1/258 | 13.5%/6 y | PBSC/BMSC; P = .004 Age >35 y;P = .07 |
| Traweek et al 199410 City of Hope | Hodgkin Non-Hodgkin | 2/2/108 5/1/167 | 9%/3 y | 5 patients with chromosome aberration: no signs of MDS |
| Krishnan et al 199811 (follow-up) | Hodgkin Non-Hodgkin | 24/612* | 9.4%/9 y | PBSC/BMSC; P = .05 Topo II inhibitors—11q23/21q22 translocations |
| Darrington et al 199412 Nebraska | Hodgkin Non-Hodgkin | 4/2/249 6/0/262 | 4%/5 y | Age ≥40 y; P = .05 TBI; P = .06 |
| Stone et al 199413 Dana Farber | Non-Hodgkin | 18/2/262 | 18%/6 y | Prolonged interval diagnosis to ASCT; P = .003 Duration of prior CT; P = .019 Radiation therapy; P = .032 Pelvic irradiation; P = .003 Age >38 y with low platelet counts |
| Friedberg et al 199914 (follow-up) | Non-Hodgkin | 41/0/552 | 19.8%/10 y | Fewer no. of cells reinfused;P = .0003 |
| Wheeler et al 199715 Dana Farber | Hodgkin Non-Hodgkin | 6/300* | 4.2%/5 y | Prior relapses; P = .009 Prior radiotherapy; P = .05 |
| Taylor et al 199716 Newcastle | Hodgkin Non-Hodgkin | 0/1/52 0/0/62 | 1.1%/20 mo (+1 CML) | 60% transplant. in 1. CR |
| Pedersen-Bjergaard et al 199717 Copenhagen | Hodgkin Non-Hodgkin | 1/1/27 3/1/49 | 24.3%/43 mo RR = 357 | Antecedent CT risk factor |
| André et al 199818 French Cooperative | Hodgkin | 5/3/467 | 4.3%/5 y | Splenectomy;P = .067 PBSC/BMSC;P = .077 |
| Harrison et al 199919British Cooperative | Hodgkin | 8/595* | 3.1%/5 y | Quantity of prior therapy; P < .0001 MOPP; P = .0009 Lomustine;P = .001 Transplant. versus non-transplant; P = .25 |
| Milligan et al 199920 EMBT Cooperative | Hodgkin Non-Hodgkin | 51/15/4998 | 4.6%/5 y 3.0%/5 y | Age at transplantation; P < .001 TBI at conditioning; P < .001 Number of transplants; P < .002 Years from diagnosis to transplantation;P < .001 |
| Govindarajan et al 199621Little Rock, Arkansas | Multiple myeloma (tandem-transpl.) | 0/0/71† 7/0/117‡ | 0% 12%/4 y | ASCT in 1. CR versus ASCT in multitreated P = .02 |
| Laughlin et al 199822 Duke University | Breast cancer | 3/2/8641-153 | 1.6%/4 y | — |
| Kollmannsberger et al 199823 German/French Cooperative | Germ cell tumors (advanced stage) | 2/4/302 | 1.3%/52 mo1-155 RR: 160 | Previously etoposide >2.4 g/m2 + Cis + Ifos/Ctx |
No discrimination between t-MDS and t-AML.
Previously received only 1 cycle of CT.
Previously received more than 1 cycle of CT.
One case of ALL with t(1;11) included.
Only 4 cases of overt AML are included, whereas 2 cases of MDS are excluded in the calculation.
Abbreviations: PBSC indicates peripheral blood stem cells; BMSC, bone marrow stem cells; TBI, total body irradiation; CT, chemotherapy; CR, complete remission; Cis, cisplatin; Ifos, ifosphamide; Ctx, cyclophosphamide; MOPP, mechlorethamine, vincristine, procarbazine, and prednisone.