Myelodysplasia After Autotransplantation
Authors: Nicolas Mounier, Christian Gisselbrecht, Jonathan W. Friedberg, Donna Neuberg, Arnold S. Freedman
Journal: Journal of Clinical Oncology (2000)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2000.18.19.3446 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11013288 Myelodysplasia After Autotransplantation Nicolas MounierxNicolas MounierSearch for articles by this author , Christian GisselbrechtxChristian GisselbrechtSearch for articles by this author Jonathan W. FriedbergxJonathan W. FriedbergSearch for articles by this author , Donna NeubergxDonna NeubergSearch for articles by this author , Arnold S. FreedmanxArnold S. FreedmanSearch for articles by this author Show More Institut d’Hématologie Hôpital Saint Louis Paris, FranceDana-Farber Cancer Institute Brigham and Women’s Hospital Harvard Medical School Boston, MA https://doi.org/10.1200/JCO.2000.18.19.3446 First Page Full Text PDF Figures and Tables © 2000 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse19102000In Reply:We agree with Drs Mounier and Gisselbrecht that it may be premature to eliminate all radiation therapy from transplantation-preparative regimens for patients with non-Hodgkin’s lymphoma solely on the basis of recently published retrospective analyses.1-3 However, there are important distinctions between our study on bone marrow transplantation for non-Hodgkin’s lymphoma and the cited study by Andre et al4 on second malignancies after autologous stem-cell transplantation for Hodgkin’s disease. In the Hodgkin’s disease study, the majority of grafted patients and conventionally treated control patients received mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy, a regimen that is independently associated with secondary acute myelogenous leukemia (AML), particularly when combined with radiotherapy.5 A control group of patients is critical in this situation, because it is important to distinguish the effects of MOPP from the effects of the chemotherapy-only conditioning regimen. Very few of our patients received MOPP-like regimens, and 10 of our patients who subsequently developed myelodysplastic syndrome (MDS) were treated only with cyclophosphamide, doxorubicin, vincristine, and prednisone before autologous stem-cell transplantation, a well-studied regimen not historically associated with MDS in standard dosing.6 Moreover, the series by Andre et al4 may have underestimated MDS risk by evaluating cumulative incidence of MDS at 5 years, which in our series was significantly shorter than the reported 10-year incidence.Mounier and Gisselbrecht are correct in noting that the cumulative incidence provides an unbiased estimate of the rate of MDS/AML in the setting in which patients who die of disease or other causes are censored for incidence of MDS/AML.7 We have reanalyzed our data and find that the cumulative incidence of MDS/AML in our series is 14.5%. This is, as expected, lower than the rate of 19.8%, which we obtained by inverting the Kaplan-Meier estimator. Nevertheless, 14.5% remains an unacceptably high rate of MDS after autologous transplantation for non-Hodgkin’s lymphoma, and novel strategies must be developed to prevent this devastating complication.1. Friedberg JW, Neuberg D, Stone RM, et al: Outcome in patients with myelodysplastic syndrome after autologous bone marrow transplantation for non-Hodgkin’s lymphoma. J Clin Oncol 17:: 3128,1999-3135, Link, Google Scholar2. Krishnan A, Bhatia S, Slovak ML, et al: Predictors of therapy-related leukemia and myelodysplasia following autologous transplantation for lymphoma: An assessment of risk factors. Blood 95:: 1588,2000-1593, Crossref, Medline, Google Scholar3. Micallef IN, Lillington DM, Apostolidis J, et al: Therapy-related myelodysplasia and secondary acute myelogenous leukemia after high-dose therapy with autologous hematopoietic progenitor-cell support for lymphoid malignancies. J Clin Oncol 18:: 947,2000-955, Link, Google Scholar4. Andre M, Henry-Amar M, Blaise D, et al: Treatment-related deaths and second cancer risk after autologous stem-cell transplantation for Hodgkin’s disease. Blood 92:: 1933,1998-1940, Medline, Google Scholar5. Jones SE, Miller TP, Connors JM: Long-term follow-up and analysis for prognostic factors for patients with limited-stage diffuse large-cell lymphoma treated with initial chemotherapy with or without adjuvant radiotherapy [see comments]. J Clin Oncol 7:: 1186,1989-1191, Link, Google Scholar6. Fisher RI, Gaynor ER, Dahlberg S, et al: Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma [see comments]. N Engl J Med 328:: 1002,1993-1006, Crossref, Medline, Google Scholar7. Gooley TA, Leisenring W, Crowley J, et al: Estimation of failure probabilities in the presence of competing risks: New representations of old estimators. Stat Med 18:: 695,1999-706, Crossref, Medline, Google Scholar