Patient age and number of apheresis days may predict development of secondary myelodysplastic syndrome and acute myelogenous leukemia after high‐dose chemotherapy and autologous stem cell transplantation for lymphoma

Ge, Isabell; Saliba, Rima M.; Maadani, Farzaneh; Popat, Uday; Qazilbash, Muzaffar H.; Pingali, Sai Ravi; Shah, Nina; Bashir, Qaiser; Nieto, Yago; Champlin, Richard E.; Hosing, Chitra

doi:10.1111/trf.14016

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…This allows us to calculate a 4.1% cumulative 5-year risk for developing subsequent myeloid disease. We show an association between that and smaller yields, and others have shown a correlation with MDS/AML and lower yields per harvest day [26], which suggests that there are underlying risk factors present before the ASCT. Indeed, preceding clonal hematopoiesis is often present before the ASCT (or prior to any therapy) in patients who develop secondary myeloid neoplasia [27–29].…”

Section: Discussionsupporting

confidence: 73%

The Karolinska experience of autologous stem-cell transplantation for lymphoma: a population-based study of all 433 patients 1994–2016

et al. 2019

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BackgroundAutologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality.MethodsAll 433 lymphoma patients who underwent ASCT for lymphoma at Karolinska Huddinge 1994–2016 were investigated, including CD34+ cell amounts, medications, infectious and other complications, intensive care, longitudinal laboratory values, and secondary myeloid neoplasia.ResultsThe 100-day non-relapse and overall mortalities were 5.6% and 7.2%. Stem-cell harvests < 5 million CD34+ cells/kg correlated with inferior 100-day and long-term survival. Prior to conditioning (93% BEAM), elevated (both 3–9 and ≥ 10 mg/L) C-reactive protein (CRP) and creatinine, and low albumin (but not higher age) predicted inferior higher 100-day survival. Intravenous antibiotics were given to 97% (22% positive blood cultures) and parenteral nutrition to 89%. After 1 year, 86% had normalized hemoglobin. The 5-year risk for secondary myeloid neoplasia was 4.1%, associated with smaller harvests.ConclusionsBefore starting conditioning, patients should have preferably harvested ≥ 5 million CD34+ cells/kg and normal CRP, albumin, and creatinine. It appears safe to transplant patients ≥ 66 years.Electronic supplementary materialThe online version of this article (10.1186/s40164-019-0131-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 73%

The Karolinska experience of autologous stem-cell transplantation for lymphoma: a population-based study of all 433 patients 1994–2016

et al. 2019

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“…None of the 54 patients had second malignancies. Age >55 years by itself was associated with higher risk of secondary AML/MDS, even in patients who needed 2 or fewer apheresis sessions [36]. This observation may help in making treatment decisions for elderly patients when other promising nontransplantation targeted therapies and immunological agents are available.…”

Section: Discussionmentioning

confidence: 80%

Age over Fifty-Five Years at Diagnosis Increases Risk of Second Malignancies after Autologous Transplantation for Patients with Hodgkin Lymphoma

Pingali

Saliba

Anderlini

et al. 2017

Biology of Blood and Marrow Transplantation

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The impact of age at diagnosis on outcomes of patients with Hodgkin lymphoma (HL) undergoing autologous hematopoietic transplantation (auto-HCT) is unclear. We retrospectively evaluated the impact of age on outcomes of 310 consecutive patients with relapsed/refractory HL who underwent auto-HCT between January 1996 and December 2010 with carmustine, etoposide, cytarabine, and melphalan conditioning therapy. Patients were stratified into ≤ 55 and >55-year-age groups based on age at diagnosis. At a median follow-up of 80 (range, 1 to 180) months, progression-free survival was similar between both age groups. However, age older than 55 years at diagnosis was associated with significantly poor overall survival with a hazard ratio [HR] of 2.3 (P = .003) from higher rate of second malignancies (HR, 3.8; P = .015) compared with patients 55 years or younger. In conclusion age > 55 years at diagnosis increases risk of second malignancies after auto-HCT.

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“…Older age is one of the risk factors that affects the development of t-AML/MDS after autologous transplantation 8 , 10 , 11 . The fact that more than 60% of the patients in this cohort were 46 years or older supports this finding.…”

Section: Discussionmentioning

confidence: 99%

“…The fact that more than 60% of the patients in this cohort were 46 years or older supports this finding. As the number of patients with autologous HSCT in Japan has increased in recent years, especially in elderly patients older than 60 years of age 12 , more cautious posttransplant follow-up including close monitoring of complete blood cell count changes will be needed for early detection of t-AML/MDS not only in this age group but also for all patients with other identified risk factors 8 , 10 .…”

Section: Discussionmentioning

confidence: 99%

Late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation

2020

BCT

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By evaluating risks of late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation (HSCT) in Japan, we clarified what we should focus on during follow-up to reduce them. The study cohort included 6,780 patients who had survived for≥2 years after the first autologous HSCT performed from 1974 to 2012 for hematological diseases. With a median follow-up of 6.0 years among survivors, overall survival probabilities at 5 and 10 years after HSCT were 92% and 83%, respectively. Eight hundred thirty deaths occurred: 451, recurrent primary diseases； 87, subsequent solid cancers； 57, subsequent hematological malignancies； 55, infections； 41, respiratory diseases； 19, cardiovascular diseases； 15, liver diseases； 10, neurological diseases； and 7, kidney／genitourinary diseases(Except small numbers of other causes and missing) . According to the log-rank test, the risk of overall mortality was remarkably increased among HSCT recipients compared with the that in the general Japanese population(observed／expected ratio［O／E］＝5.4； 95% confidence interval［CI］ , 5.0-5.8) . The risks of cause-specific mortality increased with infection(O／E＝6.8； 95% CI, 5.1-8.8) , subsequent solid cancers(O／E＝1.4； 95% CI, 1.1-1.7) , subsequent hematological malignancies(O／E＝14.3； 95% CI, 10.8-18.5) , kidney／genitourinary diseases(O／E＝3.4； 95% CI, 1.4-7.1) , respiratory disease(O／E＝9.0； 95% CI, 6.5-1.2) , and liver diseases(O／E＝2.6； 95% CI, 1.4-4.2) . Long-term survivors after autologous HSCT are at an increased risk of death due to secondary cancers, infections, and any organ diseases as well as recurrence compared to the general population. When monitoring these patients in the outpatient clinic, it is important for physicians to predict a change in the patient＇s condition and to start treatment earlier.

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Patient age and number of apheresis days may predict development of secondary myelodysplastic syndrome and acute myelogenous leukemia after high‐dose chemotherapy and autologous stem cell transplantation for lymphoma

Abstract: Our study defines a subset of relapsed or refractory lymphoma patients who should be closely monitored for development of s-MDS/AML after high-dose chemotherapy and ASCT.

Cited by 7 publications

References 20 publications

The Karolinska experience of autologous stem-cell transplantation for lymphoma: a population-based study of all 433 patients 1994–2016

The Karolinska experience of autologous stem-cell transplantation for lymphoma: a population-based study of all 433 patients 1994–2016

Age over Fifty-Five Years at Diagnosis Increases Risk of Second Malignancies after Autologous Transplantation for Patients with Hodgkin Lymphoma

Late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation

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