Predictors of therapy-related leukemia and myelodysplasia following autologous transplantation for lymphoma: an assessment of risk factors

作     者：Krishnan, A Bhatia, S Slovak, ML Arber, DA Niland, JC Nademanee, A Fung, H Bhatia, R Kashyap, A Molina, A O'Donnell, MR Parker, PA Sniecinski, I Snyder, DS Spielberger, R Stein, A Forman, SJ 

作者机构：City Hope Natl Med Ctr Div Pediat Oncol Duarte CA 91010 USA City Hope Natl Med Ctr Div Hematol & Bone Marrow Transplantat Duarte CA 91010 USA City Hope Natl Med Ctr Div Biostat & Pathol Duarte CA 91010 USA 

出 版 物：《BLOOD》 (血液)

年 卷 期：2000年第95卷第5期

页      面：1588-1593页

核心收录：

学科分类：1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 10[医学] 

基　　金：NCI NIH HHS [CA 33572  CA 30206] Funding Source: Medline 

主　　题：加利福尼亚/流行病学 病例对照研究 队列研究 综合疗法 依托泊甙/投药和剂量 造血干细胞动员/方法 白血病/化学诱导 白血病/流行病学 白血病/病因学 白血病 辐射性/流行病学 白血病 辐射性/病因学 淋巴瘤/药物疗法 淋巴瘤/放射疗法 淋巴瘤/治疗 多元分析 骨髓增生异常综合征/化学诱导 骨髓增生异常综合征/流行病学 骨髓增生异常综合征/病因学 肿瘤 继发原发性/化学诱导 肿瘤 继发原发性/流行病学 肿瘤 继发原发性/病因学 比值比 回顾性研究 危险因素 治疗结果 女(雌)性 人类 男(雄)性 中年人 

摘      要：We analyzed data on 612 patients who had undergone high-dose chemoradiotherapy (HDT) with autologous stem cell rescue for Hodgkin s disease (HD) and non-Hodgkin s lymphoma (NHL) at the City of Hope National Medical Center, to evaluate the incidence of therapy-related myelodysplasia (t-MDS) or therapy-related acute myeloid leukemia (t-AML) and associated risk factors. A retrospective cohort and a nested case-control study design were used to evaluate the role of pretransplant therapeutic exposures and transplant conditioning regimens. Twenty-two patients developed morphologic evidence of tMDS/t-AML. The estimated cumulative probability of developing morphologic t-MDS/t-AML was 8.6% +/- 2.1% at 6 years. Multivariate analysis of the entire cohort revealed stem cell priming with VP-16 (RR = 7.7, P = 0.002) to be independently associated with an increased risk of t-MDS/t-AML. The influence of pretransplant therapy on subsequent t-MDS/t-AML risk was determined by a case-control study. Multivariate analysis revealed an association between pretransplant radiation and the risk of t-MDS/t-AML, but failed to reveal any association with pretransplant chemotherapy or conditioning regimens. However, patients who had been primed with VP-16 for stem cell mobilization were at a 12.3-fold increased risk of developing t-AML with 11q23/21q22 abnormalities (P = 0.006). Patients undergoing HDT with stem cell rescue are at an increased risk of t-MDS/t-AML, especially those receiving priming with VP-16 for peripheral stem cell collection. (C) 2000 by The American Society of Hematology.