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Ann Intern Med. 1990 Apr 15;112(8):590-7.

Bone marrow transplantation for patients with myelodysplasia. Pretreatment variables and outcome.

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  • 1Fred Hutchinson Cancer Research Center, Seattle, Washington.

Abstract

STUDY OBJECTIVE:

To determine the efficacy of allogeneic bone marrow transplantation for severe myelodysplasia, and to identify variables predictive of outcome.

DESIGN:

Case series study.

SETTING:

A referral-based bone marrow transplant center.

PATIENTS:

Consecutive series of 59 patients with myelodysplasia or closely related disorders and either life-threatening cytopenia or a progressive increase in marrow blast percentage.

INTERVENTION:

Patients were treated with high-dose cyclophosphamide and total body irradiation followed by allogeneic bone marrow transplantation from either an HLA-identical (n = 45) or HLA-partially matched (n = 14) donor.

MEASUREMENTS AND MAIN RESULTS:

The product-limit estimate for disease-free survival 3 years after transplant is 45% (95% CI, 32% to 59%). The commonest causes of death after transplant were disease recurrence, interstitial pneumonia, and graft-versus-host disease, accounting for eight deaths each. In a univariate analysis, younger patients, those with shorter disease duration, and those whose disease was characterized by an abnormal cytogenetic karyotype had better survival and disease-free survival than the group as a whole. In a multivariate analysis, younger age and abnormal karyotype were independent predictors of improved disease-free survival and overall survival. Patients who received transplants when they had fewer blasts in their bone marrow had a decreased chance for disease recurrence when compared with patients with excess blasts.

CONCLUSIONS:

Bone marrow transplantation offers a potential cure for many patients with myelodysplasia. Best results can be expected in younger patients who receive transplants relatively early in their disease course.

PMID:
2183666
[PubMed - indexed for MEDLINE]
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