Incidence of therapy-related myelodysplastic syndrome/ acute myeloid leukaemia after conventional therapy or autologous stem cell transplantation for Hodgkins disease: a systematic review

Abstract

Purpose: Therapy-related myelodysplastic syndrome (t-MDS) and acute myeloid leukaemia (t-AML) are serious long-term complications following cytotoxic treatment of patients with Hodgkins disease (HD). However, reliable data on incidence of t-MDS/t-AML following conventional radio-chemotherapy or high-dose therapy with autologous stem cell transplantation (ASCT) are lacking. Design: To answer this question, a systematic review was performed. We screened the databases MEDLINE, EMBASE and Cochrane Library as well as conference proceedings and reference lists using appropriate key words. Original articles identified were checked for fulfilling strict inclusion criteria. Relevant data were then extracted form selected articles and analysed. Results: Of 3266 original articles, identified between 1979 und 2008, 56 fulfilled the inclusion criteria. Fifty-five cohort studies and one randomized controlled trial (RCT) reported on 30.572 patients. Forty-nine articles presented data on conventional and six on high-dose therapy with ASCT. The median follow-up was between five and 17.8 years. A total of 270 cases of t-MDS/t-AML were observed. Crude incidence was the most frequent measure showing a range from 0 to 5.4% in the conventional and 1.9 to 14.8% in the high-dose therapy/ASCT group. The only RCT that compared conventional and high-dose therapy with ASCT reported an incidence of t-MDS/t-AML of 0.9% and 2%, respectively. Conclusion: The results of this systematic review demonstrate that high-dose therapy with ASCT is associated with higher incidences of t-MDS/t-AML as compared to conventional therapy in patients with HD. This indicates that toxicity plays a role in the pathogenesis of these secondary malignancies.

Datum der Bewilligung	2011
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Heinz Sill (Betreuer*in) & Andrea Berghold (Mitbetreuer*in)