淋巴瘤和浆细胞骨髓瘤自体移植后发生急性髓系白血病和骨髓增生异常综合征的风险。
Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma.
作者信息
Radivoyevitch Tomas, Dean Robert M, Shaw Bronwen E, Brazauskas Ruta, Tecca Heather R, Molenaar Remco J, Battiwalla Minoo, Savani Bipin N, Flowers Mary E D, Cooke Kenneth R, Hamilton Betty K, Kalaycio Matt, Maciejewski Jaroslaw P, Ahmed Ibrahim, Akpek Görgün, Bajel Ashish, Buchbinder David, Cahn Jean-Yves, D'Souza Anita, Daly Andrew, DeFilipp Zachariah, Ganguly Siddhartha, Hamadani Mehdi, Hayashi Robert J, Hematti Peiman, Inamoto Yoshihiro, Khera Nandita, Kindwall-Keller Tamila, Landau Heather, Lazarus Hillard, Majhail Navneet S, Marks David I, Olsson Richard F, Seo Sachiko, Steinberg Amir, William Basem M, Wirk Baldeep, Yared Jean A, Aljurf Mahmoud, Abidi Muneer H, Allewelt Heather, Beitinjaneh Amer, Cook Rachel, Cornell Robert F, Fay Joseph W, Hale Gregory, Chakrabarty Jennifer Holter, Jodele Sonata, Kasow Kimberly A, Mahindra Anuj, Malone Adriana K, Popat Uday, Rizzo J Douglas, Schouten Harry C, Warwick Anne B, Wood William A, Sekeres Mikkael A, Litzow Mark R, Gale Robert P, Hashmi Shahrukh K
机构信息
Departments of Quantitative Health Sciences and Translational Hematology & Oncology Research, Cleveland Clinic Foundation, Cleveland, OH, United States.
Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio, United States.
出版信息
Leuk Res. 2018 Nov;74:130-136. doi: 10.1016/j.leukres.2018.07.016. Epub 2018 Jul 19.
BACKGROUND
Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).
METHODS
9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n = 916), non-Hodgkin lymphoma (NHL; n = 3546) and plasma cell myeloma (PCM; n = 4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS.
RESULTS
335 MDS/AML cases were diagnosed posttransplant (3.7%). Variables associated with an increased risk for AML or MDS in multivariate analyses were: (1) conditioning with total body radiation versus chemotherapy alone for HL (HR = 4.0; 95% confidence interval [1.4, 11.6]) and NHL (HR = 2.5 [1.1, 2.5]); (2) ≥3 versus 1 line of chemotherapy for NHL (HR = 1.9 [1.3, 2.8]); and (3) subjects with NHL transplanted in 2005-2010 versus 1995-1999 (HR = 2.1 [1.5, 3.1]). Using Surveillance, Epidemiology and End Results (SEER) data, we found risks for AML/MDS in HL, NHL and PCM to be 5-10 times the background rate. In contrast, relative risks were 10-50 for AML and approximately 100 for MDS in the autotransplant cohort.
CONCLUSIONS
There are substantial risks of AML and MDS after autotransplants for HL, NHL and PCM.
背景
接触DNA损伤药物和电离辐射会增加急性髓系白血病（AML）和骨髓增生异常综合征（MDS）的风险。
方法
对向血液和骨髓移植临床试验中心（CIBMTR）报告的9028例接受造血细胞自体移植（1995 - 2010年）的霍奇金淋巴瘤（HL；n = 916）、非霍奇金淋巴瘤（NHL；n = 3546）和浆细胞骨髓瘤（PCM；n = 4566）患者进行分析，以评估其后续发生AML或MDS的风险。
结果
移植后诊断出335例MDS/AML病例（3.7%）。多因素分析中与AML或MDS风险增加相关的变量为：（1）HL（风险比[HR] = 4.0；95%置信区间[CI][1.4, 11.6]）和NHL（HR = 2.5[1.1, 2.5]）采用全身放疗与单纯化疗进行预处理；（2）NHL接受≥3线化疗与1线化疗相比（HR = 1.9[1.3, 2.8]）；（3）2005 - 2010年接受移植的NHL患者与1995 - 1999年接受移植的患者相比（HR = 2.1[1.5, 3.1]）。利用监测、流行病学和最终结果（SEER）数据，我们发现HL、NHL和PCM患者发生AML/MDS的风险是背景率的5 - 10倍。相比之下，自体移植队列中AML的相对风险为10 - 50，MDS约为100。
结论
HL、NHL和PCM自体移植后发生AML和MDS的风险很高。
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