Allogeneic Bone Marrow Transplantation for Therapy-Related Myelodysplastic Syndrome and Acute Myeloid Leukemia: A Long-Term Study of 70 Patients—Report of the French Society of Bone Marrow Transplantation

TLDR

The study aimed to identify predictive factors of survival, relapse, and transplantation‑related mortality in patients with therapy‑related myelodysplastic syndrome or acute leukemia undergoing allogeneic bone marrow transplantation. The authors retrospectively analyzed 70 patients (31 t‑MDS, 39 t‑AML) who received allogeneic BMT between 1980 and 1998, with 33 having induction chemotherapy and 24 in complete remission at transplantation. With a median follow‑up of 7.9 years, the 2‑year overall survival was 30%, event‑free survival 28%, relapse 42%, and TRM 49%; older age, male sex, CMV seropositivity, lack of remission at transplant, and intensive conditioning were associated with poorer outcomes, underscoring the need for better patient selection.

Abstract

To identify predictive factors of survival, relapse, and transplantation-related mortality (TRM) among patients with therapy-related myelodysplastic syndrome (t-MDS) or acute leukemia (t-AML) who underwent allogeneic bone marrow transplantation (BMT).From 1980 to 1998, 70 patients underwent allogeneic BMT for t-MDS (n = 31) or t-AML (n = 39) after prior cytotoxic exposure. Thirty-three patients had received induction-type chemotherapy before BMT. At the time of transplantation, there were 24 patients in complete remission (CR) and 46 with active disease.With a median follow-up of 7.9 years (range, 1.1 to 18.8 years) after BMT, 16 patients are alive, whereas 19 died of relapse, 34 of TRM, and one of relapse of the primary disease. The estimated 2-year overall survival, event-free survival, relapse, and TRM rates were 30% (95% confidence interval [CI], 19% to 40%), 28% (95% CI, 18% to 39%), 42% (95% CI, 26% to 57%), and 49% (95% CI, 36% to 62%), respectively. In multivariable analysis, age greater than 37 years, male sex, positive recipient cytomegalovirus (CMV) serology, absence of CR at BMT, and intensive schedules used for conditioning were associated with poor outcome.BMT is an effective treatment for patients with t-MDS or t-AML who have responsive disease and, in particular, who have no poor-risk cytogenetic features. The poor results of the other patients, especially those with active disease at BMT, emphasize the need to delineate indications and perform prospective protocols.