Peripheral blood parameter abnormalities precede therapy-related myeloid neoplasms after autologous transplantation for lymphoma

Academic Article

Abstract

  • Background: Therapy-related myeloid neoplasms (t-MN) are a leading cause of nonrelapse mortality after autologous peripheral blood stem cell transplantation (aPBSCT) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (NHL). t-MN patients treated at an earlier stage of disease evolution have a better prognosis, and this presents a need to identify patients at risk for t-MN. Methods: Using a prospective longitudinal study design, this study evaluated peripheral blood parameters pre-aPBSCT and on day 100, at 6 months, 1 year, 2 years, and 3 years in 304 patients treated with aPBSCT. The relation between peripheral blood parameters and subsequent development of t-MN was examined, and nomograms were developed to identify patients at risk for t-MN. Results: Twenty-one patients developed t-MN at a median of 1.95 years post-aPBSCT. Hemoglobin, hematocrit, white blood cell, and platelet counts were lower among patients who developed t-MN compared to those who did not; these differences appeared soon after aPBSCT, persisted, and preceded development of t-MN. Older age at aPBSCT (hazard ratio [HR]per_year_increase = 1.08, P =.007), exposure to total body irradiation (TBI) (HR = 2.90, P =.04), and low 100-day platelet count (HRincrease_per_unit_decline_in_PLT = 1.01, P =.002) predicted subsequent t-MN. These parameters and primary diagnosis allowed identification of patients at high risk of t-MN (eg, an HL patient undergoing aPBSCT at the age of 70 years with TBI and with a day 100 PLT between 100,000 and 150,000 would have a 62% probability of developing t-MN at 6 years post-aPBSCT). Conclusions: Abnormalities in peripheral blood parameters can identify patients at high risk for t-MN after aPBSCT for HL or NHL, allowing opportunities to personalize close surveillance and possible disease-modifying interventions.
  • Published In

  • Cancer  Journal
  • Digital Object Identifier (doi)

    Author List

  • Bachiashvili K; Francisco L; Chen Y; Bosworth A; Forman SJ; Bhatia R; Bhatia S
  • Start Page

  • 1392
  • End Page

  • 1401
  • Volume

  • 128
  • Issue

  • 7