MYELODYSPLASTIC SYNDROME AS A LATE COMPLICATION FOLLOWING AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMA
MYELODYSPLASTIC SYNDROME AS A LATE COMPLICATION FOLLOWING AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMA
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DOI：
10.1200/jco.1994.12.12.2535
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发表时间：
1994-12-01
影响因子：
45.3
通讯作者：
NADLER, LM
中科院分区：
文献类型：
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作者：
STONE, RM;NEUBERG, D;NADLER, LM
目的：探讨非霍奇金淋巴瘤患者自体骨髓移植后骨髓增生异常综合征(MDS)的发生率、自然病史和相关危险因素。方法：我们回顾了1982年至1991年在达纳-法伯癌症研究所接受自体骨髓移植治疗非霍奇金淋巴瘤的262例患者的病历。虽然患者在符合移植资格之前接受了各种治疗，但每例患者都接受了相同的清髓治疗(环磷酰胺60 mg/kg/d，连用2天，加全身照射，每日2次，连用3天)。通过收集移植前和移植后早期变量的数据，我们试图确定发生MDS的危险因素。结果：移植后MDS或急性髓系白血病(AML)的粗略总发病率为7.6%。6年的精算风险为18%+/-9%。中位发病时间为移植后31个月(10-101个月)或淋巴瘤首次治疗后69个月(27-141个月)。预测MDS发生的预处理变量(单变量分析)包括：首次治疗到移植程序的间隔时间延长(P=.003)，接受化疗(P=.019)或烷化剂(P=.045)的时间延长，以及移植前接受放射治疗(P=.032)或盆腔放射(P=.003)。结论：MDS是自体骨髓移植治疗非霍奇金淋巴瘤的潜在并发症；移植前持续的骨髓干细胞损伤可能是最重要的危险因素。(C)1994年，由美国临床肿瘤学会主办。
Purpose: To determine the incidence, natural history, and risk factors associated with myelodysplastic syndrome (MDS) occurring as a late complication following autologous bone marrow transplantation for patients with non-Hodgkin's lymphoma.Methods: We retrospectively reviewed the charts of all 262 patients who underwent autologous bone marrow transplantation for non-Hodgkin's lymphoma at the Dana-Farber Cancer Institute from 1982 through 1991. Although patients received a variety of treatments before they were eligible for transplant, identical myeloablative therapy (cyclophosphamide 60 mg/kg/d for 2 days plus total-body irradiation twice daily for 3 days) was administered in each case. By collecting data on pretransplant and early posttransplant variables, we attempted to identify risk factors for the development of MDS.Results: The crude overall incidence of posttransplant MDS or acute myeloid leukemia (AML) was 7.6%. The actuarial risk at 6 years was 18% +/- 9%. The median time of onset was 31 months (range, 10 to 101) after transplant or 69 months (range, 27 to 141) after initial treatment for lymphoma. Pretreatment variables predictive for the development of MDS (univariate analysis) included prolonged interval between initial treatment and the transplant procedure (P =.003), increased duration of exposure to chemotherapy (P =.019) or to alkylating agents (P =.045), and use of radiation therapy (P =.032) or pelvic radiation (P =.003) before transplant.Conclusion: MDS is a potential complication of autologous bone marrow transplantation for non-Hodgkin's lymphoma; bone marrow stem-cell damage sustained before the transplant may be the most important risk factor. (C) 1994 by American Society of Clinical Oncology.