Risk of Acute Myeloid Leukemia and Myelodysplastic Syndrome After Autotransplants for Lymphomas and Plasma Cell Myeloma

Leuk Res. 2018 Nov;74:130-136. doi: 10.1016/j.leukres.2018.07.016. Epub 2018 Jul 19.

Abstract

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.

Keywords: AML; Autotransplant; CIBMTR; MDS; New cancers; SEER; Therapy-related.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Leukemia, Myeloid, Acute* / epidemiology
  • Leukemia, Myeloid, Acute* / etiology
  • Leukemia, Plasma Cell* / epidemiology
  • Leukemia, Plasma Cell* / therapy
  • Lymphoma / epidemiology
  • Lymphoma / therapy
  • Male
  • Middle Aged
  • Myelodysplastic Syndromes* / epidemiology
  • Myelodysplastic Syndromes* / etiology
  • Neoplasms, Second Primary*
  • Risk Factors
  • Transplantation, Autologous