Sevilla J, Rodríguez A, Hernández-Maraver D, de Bustos G, Aguado J, Ojeda E, Arrieta R, Hernández-Navarro F
Banco de Sangre, Hospital Niño Jesús, Av/Menéndez Pelayo 65, Madrid 28009, Spain.
Ann Hematol. 2002 Jan;81(1):11-5. doi: 10.1007/s00277-001-0400-0. Epub 2001 Dec 8.
Secondary myelodysplastic syndrome (MDS) and acute leukemia (AL) are well-known complications of antineoplastic therapy. The incidence of these serious complications after autologous hematopoietic transplantation ranges from 1.1% to 24%. Prior chemotherapy is its most likely cause, but other variables related to these long-term complications are seriously discussed. There is evidence that priming of progenitor cells isolated from peripheral blood with chemotherapy is also related to a higher risk of secondary MDS/AL. Whether progenitor cells isolated from bone marrow or peripheral blood after mobilization only with cytokines are related to higher risk is a controversial issue. In this paper, we analyze the incidence and variables related to these complications in a series of 99 patients diagnosed with lymphoma or multiple myeloma who underwent autologous transplantation using hematopoietic progenitors isolated from peripheral blood mobilized with granulocyte colony-stimulating factor (G-CSF). The probability of MDS/AL in patients alive 5 years after transplant in our series is 8.58%, similar to that reported in other series using bone marrow grafts. The total dose of cyclophosphamide ( p=0.099), the number of chemotherapy cycles ( p=0.04) received before transplant, and the total dose of mononuclear cells infused at the time of transplant were the only variables associated with secondary MDS/AL. Autologous transplantation with progenitor cells isolated from peripheral blood after mobilization with cytokines has probability and risk factors for secondary MDS/AL development similar to bone marrow grafts when compared with other published series.
继发性骨髓增生异常综合征（MDS）和急性白血病（AL）是抗肿瘤治疗的常见并发症。自体造血移植后这些严重并发症的发生率在1.1%至24%之间。先前的化疗是其最可能的原因，但与这些长期并发症相关的其他变量也受到了深入讨论。有证据表明，用化疗对外周血分离的祖细胞进行预处理也与继发性MDS/AL的较高风险相关。仅通过细胞因子动员后从骨髓或外周血分离的祖细胞是否与较高风险相关是一个有争议的问题。在本文中，我们分析了99例诊断为淋巴瘤或多发性骨髓瘤的患者的这些并发症的发生率及相关变量，这些患者接受了使用从经粒细胞集落刺激因子（G-CSF）动员的外周血中分离的造血祖细胞进行的自体移植。在我们的系列研究中，移植后存活5年的患者发生MDS/AL的概率为8.58%，与其他使用骨髓移植的系列报道相似。环磷酰胺的总剂量（p = 0.099）、移植前接受的化疗周期数（p = 0.04）以及移植时输注的单个核细胞的总剂量是与继发性MDS/AL相关的仅有的变量。与其他已发表的系列相比，用细胞因子动员后从外周血分离的祖细胞进行自体移植发生继发性MDS/AL的概率和危险因素与骨髓移植相似。
