Cytogenetically defined myelodysplasia after melphalan-based autotransplantation for multiple myeloma linked to poor hematopoietic stem-cell mobilization: The Arkansas experience in more than 3000 patients treated since 1989

Bart Barlogie, Guido Tricot, Jeff Haessler, Frits Van Rhee, Michele Cottler-Fox, Elias Anaissie, James Waldron, Mauricio Pineda-Roman, Raymond Thertulien, Maurizio Zangari, Klaus Hollmig, Abid Mohiuddin, Yazan Alsayed, Antje Hoering, John Crowley, Jeffrey Sawyer

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Abstract

Myelodysplastic syndrome (MDS) is a well-recognized complication of chemotherapy for multiple myeloma (MM). Serial bone marrow metaphase examinations were performed for MM restaging in 3077 patients undergoing high-dose therapy (HDT). MDS-associated cytogenetic abnormalities (MDS-CAs) were observed in 105 of 2418 patients in whom cytogenetic data were available after HDT. MDS-CAs occurred transiently in 72 patients and on 3 successive occasions (persistent MDS-CAs) in 33 patients, for 10-year estimates of 4% and 2%, respectively; only 21 patients developed overt clinical MDS and 5, acute myeloblastic leukemia (AML). MDS-CA development was linked to lower CD34 yield at collection, longer time interval from MM diagnosis to HDT, older age, and lower platelet recovery after HDT; persistent MDS-CAs were predicted by CD34 yield of less than 3 × 106/kg and need for more than 2 apheresis procedures. Applying a tertile frequency distribution over time to all 105 patients with MDS-CAs, its detection early after HDT was associated with longer time interval from diagnosis and low pre-HDT platelet count (likely resulting from pre-HDT damage), whereas late-onset MDS-CAs were noted among patients treated with Total Therapy 2 and Total Therapy 3 that applied post-HDT consolidation chemotherapy (suggesting possible post-HDT damage). While the risk of MDS-CAs was low and clinical MDS occurred infrequently, monitoring after post-HDT consolidation chemotherapy appears warranted.

Original languageEnglish (US)
Pages (from-to)94-100
Number of pages7
JournalBlood
Volume111
Issue number1
DOIs
StatePublished - Jan 1 2008

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Hematopoietic Stem Cell Mobilization
Melphalan
Chemotherapy
Autologous Transplantation
Myelodysplastic Syndromes
Stem cells
Multiple Myeloma
Platelets
Consolidation
Bone
Therapeutics
Consolidation Chemotherapy
Recovery
Monitoring
Bone Marrow Examination
Blood Component Removal
Metaphase
Platelet Count
Acute Myeloid Leukemia
Cytogenetics

ASJC Scopus subject areas

  • Hematology

Cite this

Cytogenetically defined myelodysplasia after melphalan-based autotransplantation for multiple myeloma linked to poor hematopoietic stem-cell mobilization : The Arkansas experience in more than 3000 patients treated since 1989. / Barlogie, Bart; Tricot, Guido; Haessler, Jeff; Van Rhee, Frits; Cottler-Fox, Michele; Anaissie, Elias; Waldron, James; Pineda-Roman, Mauricio; Thertulien, Raymond; Zangari, Maurizio; Hollmig, Klaus; Mohiuddin, Abid; Alsayed, Yazan; Hoering, Antje; Crowley, John; Sawyer, Jeffrey.

In: Blood, Vol. 111, No. 1, 01.01.2008, p. 94-100.

Research output: Contribution to journalArticle

Barlogie, B, Tricot, G, Haessler, J, Van Rhee, F, Cottler-Fox, M, Anaissie, E, Waldron, J, Pineda-Roman, M, Thertulien, R, Zangari, M, Hollmig, K, Mohiuddin, A, Alsayed, Y, Hoering, A, Crowley, J & Sawyer, J 2008, 'Cytogenetically defined myelodysplasia after melphalan-based autotransplantation for multiple myeloma linked to poor hematopoietic stem-cell mobilization: The Arkansas experience in more than 3000 patients treated since 1989', Blood, vol. 111, no. 1, pp. 94-100. https://doi.org/10.1182/blood-2007-06-097444
Barlogie, Bart ; Tricot, Guido ; Haessler, Jeff ; Van Rhee, Frits ; Cottler-Fox, Michele ; Anaissie, Elias ; Waldron, James ; Pineda-Roman, Mauricio ; Thertulien, Raymond ; Zangari, Maurizio ; Hollmig, Klaus ; Mohiuddin, Abid ; Alsayed, Yazan ; Hoering, Antje ; Crowley, John ; Sawyer, Jeffrey. / Cytogenetically defined myelodysplasia after melphalan-based autotransplantation for multiple myeloma linked to poor hematopoietic stem-cell mobilization : The Arkansas experience in more than 3000 patients treated since 1989. In: Blood. 2008 ; Vol. 111, No. 1. pp. 94-100.
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abstract = "Myelodysplastic syndrome (MDS) is a well-recognized complication of chemotherapy for multiple myeloma (MM). Serial bone marrow metaphase examinations were performed for MM restaging in 3077 patients undergoing high-dose therapy (HDT). MDS-associated cytogenetic abnormalities (MDS-CAs) were observed in 105 of 2418 patients in whom cytogenetic data were available after HDT. MDS-CAs occurred transiently in 72 patients and on 3 successive occasions (persistent MDS-CAs) in 33 patients, for 10-year estimates of 4{\%} and 2{\%}, respectively; only 21 patients developed overt clinical MDS and 5, acute myeloblastic leukemia (AML). MDS-CA development was linked to lower CD34 yield at collection, longer time interval from MM diagnosis to HDT, older age, and lower platelet recovery after HDT; persistent MDS-CAs were predicted by CD34 yield of less than 3 × 106/kg and need for more than 2 apheresis procedures. Applying a tertile frequency distribution over time to all 105 patients with MDS-CAs, its detection early after HDT was associated with longer time interval from diagnosis and low pre-HDT platelet count (likely resulting from pre-HDT damage), whereas late-onset MDS-CAs were noted among patients treated with Total Therapy 2 and Total Therapy 3 that applied post-HDT consolidation chemotherapy (suggesting possible post-HDT damage). While the risk of MDS-CAs was low and clinical MDS occurred infrequently, monitoring after post-HDT consolidation chemotherapy appears warranted.",
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AU - Pineda-Roman, Mauricio

AU - Thertulien, Raymond

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AU - Hollmig, Klaus

AU - Mohiuddin, Abid

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AU - Crowley, John

AU - Sawyer, Jeffrey

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N2 - Myelodysplastic syndrome (MDS) is a well-recognized complication of chemotherapy for multiple myeloma (MM). Serial bone marrow metaphase examinations were performed for MM restaging in 3077 patients undergoing high-dose therapy (HDT). MDS-associated cytogenetic abnormalities (MDS-CAs) were observed in 105 of 2418 patients in whom cytogenetic data were available after HDT. MDS-CAs occurred transiently in 72 patients and on 3 successive occasions (persistent MDS-CAs) in 33 patients, for 10-year estimates of 4% and 2%, respectively; only 21 patients developed overt clinical MDS and 5, acute myeloblastic leukemia (AML). MDS-CA development was linked to lower CD34 yield at collection, longer time interval from MM diagnosis to HDT, older age, and lower platelet recovery after HDT; persistent MDS-CAs were predicted by CD34 yield of less than 3 × 106/kg and need for more than 2 apheresis procedures. Applying a tertile frequency distribution over time to all 105 patients with MDS-CAs, its detection early after HDT was associated with longer time interval from diagnosis and low pre-HDT platelet count (likely resulting from pre-HDT damage), whereas late-onset MDS-CAs were noted among patients treated with Total Therapy 2 and Total Therapy 3 that applied post-HDT consolidation chemotherapy (suggesting possible post-HDT damage). While the risk of MDS-CAs was low and clinical MDS occurred infrequently, monitoring after post-HDT consolidation chemotherapy appears warranted.

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