Miller J S, Arthur D C, Litz C E, Neglia J P, Miller W J, Weisdorf D J
Department of Medicine, University of Minnesota Medical School, Minneapolis.
Blood. 1994 Jun 15;83(12):3780-6.
Myelodysplastic syndrome (MDS) is a complication of conventional antineoplastic therapy but has rarely been reported after autologous bone marrow transplantation (ABMT). We reviewed records of 206 patients who underwent ABMT for lymphoma at the University of Minnesota (Minneapolis, MN) between 1974 and 1993. Of 206 patients who underwent ABMT for non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD), 9 patients developed an MDS or secondary acute leukemia between 5 and 60 months (median 34 months) post-BMT. Two patients had relapsed after transplant and received additional therapy before the diagnosis of MDS. They were censored from the statistical analysis, resulting in a cumulative incidence of 14.5% +/- 11.6% (95% confidence interval) at 5 years. Three patients (15.2% +/- 18.0%) had HD, and four (14.0% +/- 14.7%) had NHL. In vitro BM purging had no affect on the incidence of MDS, although patients receiving peripheral blood stem cells had a projected MDS incidence of 31% +/- 33% versus 10.5% +/- 12% if BM cells were used (p = .0035). The patients had received a median of 14 cycles (range, 6 to 40) of chemotherapy before autologous transplantation; Five of nine patients received radiation therapy before BMT conditioning, and all patients received radiation before the diagnosis of MDS. No BM cytogenetic abnormalities were evident pretransplant in three of three patients studied, and all nine had normal pretransplant BM morphology. All patients had morphologic BM findings typical of MDS, and six of six studied had clonal cytogenetic abnormalities. At the diagnosis of MDS, all nine patients were without clinical, radiographic, or autopsy evidence of recurrent lymphoma; Three of the nine patients have died from complications of cytopenias at 23, 36, and 45 months after transplant (3 to 10 months after the diagnosis of MDS), whereas 6 survive 8 to 63 months after transplantation (1 to 34 months post-MDS). These data emphasize the cumulative leukemogenic potential of standard and salvage radiation and chemotherapy regimens and highlight treatment-induced MDS as an important and frequent late complication of potentially curative BM transplant therapy.
骨髓增生异常综合征（MDS）是传统抗肿瘤治疗的一种并发症，但自体骨髓移植（ABMT）后鲜有报道。我们回顾了1974年至1993年间在明尼苏达大学（明尼阿波利斯，明尼苏达州）接受ABMT治疗淋巴瘤的206例患者的记录。在206例接受ABMT治疗非霍奇金淋巴瘤（NHL）或霍奇金病（HD）的患者中，9例在BMT后5至60个月（中位时间34个月）发生了MDS或继发性急性白血病。2例患者移植后复发，在诊断为MDS之前接受了额外治疗。在统计分析中对他们进行了截尾处理，5年时累积发病率为14.5%±11.6%（95%置信区间）。3例患者（15.2%±18.0%）患有HD，4例（14.0%±14.7%）患有NHL。体外骨髓净化对MDS的发病率没有影响，但接受外周血干细胞的患者预计MDS发病率为31%±33%，而使用骨髓细胞时为10.5%±12%（p = 0.0035）。患者在自体移植前接受化疗的中位周期数为14个周期（范围为6至40个周期）；9例患者中有5例在BMT预处理前接受了放疗，所有患者在诊断为MDS之前均接受了放疗。在研究的3例患者中，3例移植前骨髓细胞遗传学无明显异常，所有9例移植前骨髓形态均正常。所有患者骨髓形态学表现均为典型的MDS，6例研究对象中有6例存在克隆性细胞遗传学异常。在诊断为MDS时，所有9例患者均无复发性淋巴瘤的临床、影像学或尸检证据；9例患者中有3例在移植后23、36和45个月（诊断为MDS后）死于血细胞减少症并发症，而6例在移植后8至63个月（MDS后1至34个月）存活。这些数据强调了标准和挽救性放疗及化疗方案的累积致白血病潜力，并突出了治疗诱导的MDS作为潜在治愈性骨髓移植治疗的一种重要且常见的晚期并发症。
