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

Research output: Contribution to journalArticle

55 Scopus citations

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

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    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, 111(1), 94-100. https://doi.org/10.1182/blood-2007-06-097444