Risk factors before autologous stem-cell transplantation for lymphoma predict for secondary myelodysplasia and acute myelogenous leukemia
Risk factors before autologous stem-cell transplantation for lymphoma predict for secondary myelodysplasia and acute myelogenous leukemia
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DOI：
10.1200/jco.2006.06.0673
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发表时间：
2006-08-01
影响因子：
45.3
通讯作者：
Bolwell, Brian
中科院分区：
文献类型：
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作者：
Kalaycio, Matt;Rybicki, Lisa;Bolwell, Brian
目的自体干细胞移植（ASCT）后治疗相关骨髓增生异常综合征（t-MDS）和急性骨髓性白血病（AML）的风险因素与增加干细胞收获困难风险的风险因素相似。我们回顾了526例接受ASCT治疗的淋巴瘤患者的经验，以确定干细胞采集困难是否预示t-MDS/AML风险增加。（G-CSF;或粒细胞-巨噬细胞集落刺激因子）单独（n = 334），依托泊苷和G-CSF（n = 166），或环磷酰胺和G-CSF与或不与依托泊苷（n = 26）。困难的收获是那些需要超过5天收集足够的干细胞和那些需要使用依托泊苷和/或环磷酰胺加G-CSF的额外尝试的收获（n = 52）。所有患者均接受大剂量化疗，并观察outcome.Results生存患者的中位随访时间为69个月，20例患者发生t-MDS/AML，10年的精算发病率为6.8%。移植前的特征，包括年龄，非霍奇金淋巴瘤或霍奇金病的诊断，骨髓受累，既往放射治疗，既往化疗，ASCT时的乳酸脱氢酶，疾病状态和干细胞动员方法，然后进行分析，相对于随后的发展t-MDS/AML。通过多变量分析，既往接受过放疗、4种或更多种化疗方案以及采集足够干细胞所需的单采时间超过5天被确定为t-MDS/AML的独立风险因素。Bootstrap分析证实了这些结果。结论这些结果表明，可识别的移植前因素预测ASCT后的t-MDS/AML。
Purpose The risk factors for treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (AML) after autologous stem-cell transplantation (ASCT) are similar to those that increase the risk of difficult stem-cell harvests. We reviewed our experience in 526 patients with lymphoma treated by ASCT to determine whether difficult stem-cell harvests predict for an increased risk of t-MDS/AML.Patients and Methods Autologous peripheral stem cells were initially mobilized with granulocyte colony-stimulating factor (G-CSF; or granulocyte-macrophage colony-stimulating factor) alone (n = 334), etoposide and G-CSF (n = 166), or cyclophosphamide and G-CSF with or without etoposide (n = 26). Difficult harvests were those that required more than 5 days to collect enough stem cells and those that required additional attempts with etoposide and/or cyclophosphamide plus G-CSF (n = 52). All patients were then treated with high-dose chemotherapy alone and observed for outcome.Results With a median follow-up time for surviving patients of 69 months, 20 patients developed t-MDS/AML, for an actuarial incidence of 6.8% at 10 years. Pretransplantation characteristics, including age, diagnosis of non-Hodgkin's lymphoma or Hodgkin's disease, bone marrow involvement, prior radiation therapy, prior exposure to chemotherapy, lactate dehydrogenase at the time of ASCT, disease status, and method of stem-cell mobilization, were then analyzed with respect to the subsequent development of t-MDS/AML. By multivariable analysis, prior exposure to radiation therapy, four or more chemotherapy regimens, and more than 5 days of apheresis needed to harvest enough stem cells were identified as independent risk factors for t-MDS/AML. Bootstrap analysis confirmed these results.Conclusion These results suggest that identifiable pretransplantation factors predict for t-MDS/AML after ASCT.