Myelodysplastic syndrome evolving from aplastic anemia treated with immunosuppressive therapy: efficacy of hematopoietic stem cell transplantation
Sung-Yong Kim,
Jennifer Le Rademacher,
Joseph H. Antin,
Paolo Anderlini,
Mouhab Ayas,
Minoo Battiwalla,
Jeanette Carreras,
Joanne Kurtzberg,
Ryotaro Nakamura,
Mary Eapen,
H. Joachim Deeg
Affiliations
Sung-Yong Kim
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA;;KonKuk University Medical Center, KonKuk University School of Medicine, Seoul, Republic of Korea;
Jennifer Le Rademacher
Center for International Blood & Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;;Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA;
Joseph H. Antin
Dana-Farber Cancer Institute, Boston, MA, USA;
Paolo Anderlini
The University of Texas MD Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA;
Mouhab Ayas
Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia;
Minoo Battiwalla
National Heart, Lung, and Blood Institute, Hematology Branch, National Institutes of Health, Bethesda, MD, USA;
Jeanette Carreras
Center for International Blood & Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;
Joanne Kurtzberg
Dept of Pediatrics/Pediatrics Blood & Marrow Transplantation, Duke University Medical Center, Durham, NC, USA;
Ryotaro Nakamura
City of Hope National Medical Center, Duarte, CA, USA; and
Mary Eapen
Center for International Blood & Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;
H. Joachim Deeg
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA;
A proportion of patients with aplastic anemia who are treated with immunosuppressive therapy develop clonal hematologic disorders, including post-aplastic anemia myelodysplastic syndrome. Many will proceed to allogeneic hematopoietic stem cell transplantation. We identified 123 patients with post-aplastic anemia myelodysplastic syndrome who from 1991 through 2011 underwent allogeneic hematopoietic stem cell transplantation, and in a matched-pair analysis compared outcome to that in 393 patients with de novo myelodysplastic syndrome. There was no difference in overall survival. There were no significant differences with regard to 5-year probabilities of relapse, non-relapse mortality, relapse-free survival and overall survival; these were 14%, 40%, 46% and 49% for post-aplastic anemia myelodysplastic syndrome, and 20%, 33%, 47% and 49% for de novo myelodysplastic syndrome, respectively. In multivariate analysis, relapse (hazard ratio 0.71; P=0.18), non-relapse mortality (hazard ratio 1.28; P=0.18), relapse-free survival (hazard ratio 0.97; P=0.80) and overall survival (hazard ratio 1.02; P=0.88) of post-aplastic anemia myelodysplastic syndrome were similar to those of patients with de novo myelodysplastic syndrome. Cytogenetic risk was independently associated with overall survival in both groups. Thus, transplant success in patients with post-aplastic anemia myelodysplastic syndrome was similar to that in patients with de novo myelodysplastic syndrome, and cytogenetics was the only significant prognostic factor for post-aplastic anemia myelodysplastic syndrome patients.
