autologous blood and marrow transplantation - Blog Science ...

Reece et al.
Table 3. Causes of nonrelapse mortality after autologous transplantation in 100 patients
with Hodgkin's disease
Early «day 100) (n=8)
Sepsis
1
Regimen-related toxicity 5
Miscellaneous 2
Late (>day 100) (n=9)
Pulmonary fibrosis
4
Secondary malignancy 3
Infection
Motor vehicle accident 1
Prior exposure to nitrosoureas was the most important risk for the development
of lung toxicity after autoSCT (/M1.001) in our series. Although prior chest
irradiation has been associated with an increased risk in some studies, 11
' 12
analysis did not find a significant association between radiotherapy and pulmonary
toxicity (P=0.68) (D.E.R., unpublished data).
Few details are available regarding late fatal infections after autoSCT.
However, a survey of transplant series indicates that the raw incidence may be as
high as 3% in patients with Hodgkin's disease. Bacterial, viral, and fungal
organisms have all been implicated. 6-9
The relative contributions of the known T
cell defect in this disease 13
and of posttransplant immunodeficiency 14
are unknown
at present.
Secondary malignancies represent one of the most ominous complications seen
after autoSCT. Gisselbrecht et al. in France have recently reported the findings of
a large registry analysis of Hodgkin's disease patients. At a median follow-up of 23
months, the cumulative incidence of secondary cancers after autoSCT was 8.9%, 15
comparable to our single-institution results in patients with longer follow-up. The
incidence was similar for MDS/AML (4.3%; 95% CI 1.9-9.3%) and for solid
tumors (3.7%; 95% CI 1.8-7.3%). 15
Several other studies confirm that the cumulative incidence of secondary
MDS/AML for Hodgkin's disease after autoSCT is, in general, from 5 to 10% at 5
to 10 years after transplant. 15-18
1
145
our
Secondary MDS/AML after autoSCT is typically
seen 3-6 years after diagnosis and 0.8-4 years after autoSCT; 15-18
the interval from
diagnosis is similar to that reported for MDS/AML after conventional therapy. 19
The French study included a matched analysis that compared the risk of
MDS/AML after autoSCT vs. conventional therapy. The incidence was not signif­
icantly different in the two treatment groups. 15
A number of risk factors for the development of MDS/AML after conventional
therapy have been reported, including heavy alkylator use, combined modality
therapy, and, in some studies, splenectomy. 19
' 20
Possible risk factors for MDS/AML