Possible Role of Engraftment Syndrome in Myelodysplastic Syndrome after Autologous Transplants
MW Beaty, M Pettenati, DH Hurd, Y Keung. Wake Forest University School of Medicine, Winston-Salem, NC
Background: Autologous graft versus host disease (GVHD) and engraftment syndrome (ES) probably result from host immune dysfunction during the recovery from high dose chemotherapy and radiation. Since impaired immunity has been associated with myelodysplastic syndrome, we explore the risk factors of post-transplant myelodysplastic syndrome (MDS), specifically, in relation to the GVHD and ES.
Design: Review of clinical features and diagnostic material in consecutive patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL) undergoing autologous transplantation in our institution 1991 to 2006.
Results: 452 lymphoma patients underwent autologous transplants in this period; median age of 50 years (range 16-76). 85 patients with HL and 367 NHL, of which, 291 are B-cell, 47 T-cell and 29 unknown. Total of 277 received TBI-based and 175 chemotherapy-alone conditioning regimens; 98 patients received transplantation of the bone marrow, 343 peripheral blood stem cells and 11 both. 32 patients (7%) died of regimen-related toxicity within 100 days of transplant. Eleven patients developed severe engraftment syndrome (high fever, skin rash pulmonary infiltrate requiring systemic steroid); 27 patients had skin and 2 patients had gastrointestinal biopsies consistent with GVHD. Twenty-four patients (5.3%) developed MDS with median time of onset of 4.2 years (range 8 months-7.5 years). Additional 5 patients developed clonal karyotypic abnormalities in the bone marrow without clinical MDS. The incidences of MDS are similar in HL and NHL. Significant risk factors of developing MDS include older age, advanced stage, onset of ES or GVHD, and longer intervals between the initial diagnoses to transplant.
Conclusions: Overall incidence of MDS is 5.3%. The actuarial risk at 8 years is up to 15% and may be higher in selected patients such as older age, and prolonged interval from initial diagnosis to transplant (a surrogate for prior chemotherapy). The association of engraftment syndrome and GVHD to MDS is intriguing. It is conceivable that perturbation to the host immunity caused by prior chemotherapy and/or conditioning regimens in the elderly may play a role in the development of MDS after autologous transplant.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 188, Wednesday Afternoon