Therapeutic decision making in BMT/SCT for myelodysplasia

Disease staging and classification page 85 Cytogenetic abnormalities 87 Characteristics of MDS and acute myeloid leukemia secondary to prior chemotherapy 88 Options for conventional treatment for MDS 88 Results with conventional therapy and new agents 89 Results with autologous transplant 91 Results with allogeneic transplant 92 Indications for transplant 97 HLA-identical family member transplant 97 HLA-matched (for 9 of 10 antigens) family member or matched unrelated transplant 97 Autologous blood/marrow stem cell transplant 97 Contraindications to transplant 97 Pretransplant workup 98 Monitoring posttransplant 98 Further reading 98 Disease staging and classification Cytogenetic abnormalities Characteristics of MDS and acute myeloid leukemia secondary to prior chemotherapy In addition to de novo presentation, MDS and acute myeloid leukemia (AML) can occur secondary to prior cytotoxic chemotherapy, in which case, there is a poorer prognosis than with de novo disease. Secondary MDS/AML has been found to be associated with use of the following agents: Alkylating agents (e.g., MOPP, especially if radiotherapy also used): MDS with abnormalities of chromosome 5 or 7 Epipodophyllotoxins: AML with short latency (1–3 years); M4 or M5 FAB subtype; 11q23 abnormalities Anthracyclines: AML with properties similar to those of epipodophyllotoxin-induced AML Taxanes/cyclophosphamide: Increased risk with high-dosage regimens using these agents; AML with properties similar to those of anthracycline-induced AML Compared with de novo AML, secondary AML (or treatment-related AML) is less likely to enter CR with conventional chemotherapy; is more likely to show prolonged cytopenia during remission induction; features a shorter duration of CR1 (5–23 months in reported series studies); entails shorter survival