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Does autologous transplantation directly increase the risk of secondary leukemia in lymphoma patients?

Bone Marrow Transplantation volume 39, pages 59–70 (2007)Cite this article

Abstract

Patients who undergo autologous stem cell transplantation (ASCT) for lymphoma have a significant risk of therapy-related acute myeloid leukemia and myelodysplasia (t-AML/MDS). Compared to that seen in other indications such as breast cancer, multiple myeloma or germ cell tumors, there is a substantially increased risk for t-AML/MDS following ASCT for lymphoma. This risk has largely been attributed to the extent of pre-transplant chemotherapy and radiation therapy. In many of the larger series to date, it has not been possible to directly implicate autologous transplantation itself as a risk factor for t-AML/MDS. Although pre-transplant therapy is certainly an important factor in the development of t-AML/MDS, specific components of the autologous transplantation procedure itself may also contribute to the risk of t-AML/MDS. Specifically, priming chemotherapy, total body irradiation, and the extensive cellular proliferation which occurs during engraftment may all play a role in the development of t-AML/MDS. Furthermore, there is an increasing body of evidence that certain inherited polymorphisms in genes governing drug metabolism, DNA repair and leukemogenesis may influence susceptibility to t-AML/MDS. In this paper, we review the evidence implicating the above risk factors for t-AML/MDS, present a potential mechanism for t-AML/MDS and propose interventions to reduce the rate of t-AML/MDS in lymphoma patients.

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Acknowledgements

This work was supported by a grant from the National Institutes of Health (P01 CA101937), the Barnes-Jewish Hospital Foundation, and the Medical College of Wisconsin Clinical Research Scholars Program.

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Authors and Affiliations

  1. Division of Neoplastic Diseases and Related Disorders, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    C R Hake & T S Fenske

  2. Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA

    T A Graubert

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  1. C R Hake
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  2. T A Graubert
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  3. T S Fenske
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Correspondence to T S Fenske.

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Hake, C., Graubert, T. & Fenske, T. Does autologous transplantation directly increase the risk of secondary leukemia in lymphoma patients?. Bone Marrow Transplant 39, 59–70 (2007). https://doi.org/10.1038/sj.bmt.1705547

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