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. 2010 Mar 4;115(9):1850-7.
doi: 10.1182/blood-2009-10-249128. Epub 2009 Dec 23.

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

Mark R Litzow  1 , 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, Daniel J Weisdorf
Affiliations

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

Mark R Litzow et al. Blood. .

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.

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Figures

Figure 1
Figure 1
Cumulative incidence of treatment-related mortality by disease status at transplantation after allogeneic hematopoietic cell transplantation (HCT) for therapy-related acute myeloid leukemia (AML) and myelodysplactic syndrome (MDS).
Figure 2
Figure 2
Cumulative incidence of relapse by disease status at transplantation after allogeneic HCT for therapy-related AML and MDS.
Figure 3
Figure 3
Probability of survival. (A) Disease-free survival by disease status at transplantation, (B) leukemia-free survival by type of donor, and (C) overall survival by disease status at transplantation after allogeneic HCT for therapy-related AML and MDS.
Figure 4
Figure 4
Probability of overall survival after allogeneic HCT for therapy-related AML and MDS, by risk factors.
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