Certain Variables Predict Risk of Secondary Leukemia After Stem Cell Transplant

Certain Variables Predict Risk of Secondary Leukemia After Stem Cell Transplant

According to an article recently published in the Journal of Clinical Oncology, patients diagnosed with lymphoma who were previously treated with radiation therapy, those treated with four or more chemotherapy regimens, and those who take five days to collect enough stem cells for a transplant are at a higher risk of developing myelodysplastic syndromes or acute myeloid leukemia associated with a stem cell transplant.

Lymphoma refers to several different types of cancers that originate in the immune system. The different types of lymphoma are classified according to the type of immune cell where the cancer originates, the aggressiveness of the cancer, and specific variables associated with the cancer cells.

Autologous stem cell transplant is one treatment option often used for patients with lymphoma. During this procedure higher than normal doses of therapy are utilized. Prior to the high-dose therapy, a patients stem cells are collected and then infused back into the patient following therapy.

Unfortunately, some patients who undergo an autologous stem cell transplant are at a higher risk of ultimately developing MDS or AML from the treatment, referred to treatment-related MDS or AML (t-MDS or AML) or secondary MDS or AML. Researchers continue to evaluate specific variables associated with the development of t-MDS or AML so that patients who are at a higher risk of developing these diseases can either explore alternative treatment options or undergo close monitoring.

Researchers from the Cleveland Clinic recently conducted a study to try to identify variables that may be associated with the development of t-MDS/AML among lymphoma patients. This study included 526 patients who were treated with an autologous stem cell transplant.

  • Approximately 7% of patients developed t-MDS/AML.
  • Patients with a prior exposure to radiation therapy had an increased risk of t-MDS/AML.
  • Patients who had received four or more chemotherapy regimens had an increased risk of t-MDS/AML.
  • More than five days of stem cell collection (in order to collect enough stem cells for transplantation) was associated with an increased risk of t-MDS/AML.

The researchers concluded that patients with prior radiation exposure, those who were treated with four or more chemotherapy regimens, and those whose stem cell collection took five or more days had a significantly increased risk of developing t-MDS/AML. Patients with lymphoma who have received extensive prior therapies may wish to speak with their physician about their individual risks of t-MDS/AML if they are to undergo stem cell transplantation.

Reference: Kalaycio M, Rybicki L, Pohlman B, et al. Risk Factors Before Autologous Stem-Cell Transplantation for Lymphoma Predict for Secondary Myelodysplasia and Acute Myelogenous Leukemia. Journal of Clinical Oncology. 2006;24: 3604-3610.

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