[nadia33]

myelodysplastic syndrome... after auto transplant

by nadia33 on Sun Aug 07, 2011 11:50 pm

Hi I recently heard that a danger of autologous transplant could b development of myelodysplastic syndrome and lead to AML. What are your thoughts and experience ? What are the chances of this happening ?

[Dr. Edward Libby]

Re: myelodysplastic syndrome... after auto transplant

by Dr. Edward Libby on Mon Aug 08, 2011 11:07 am

This is an important question. There does appear to be an increased risk of acute myelogenous leukemia (AML) and/or myelodysplastic syndrome (MDS) in patients with myeloma. For decades physicians have thought that the increased risk of second cancers was due primarily to the use of high-dose melphalan in the autologous stem cell transplant regimen/chemotherapy. A very recent study in the important journal BLOOD challenges this idea. In a well done epidemiologic study of patients with myeloma in Sweden it was found that the increased risk of AML/MDS was also present in patients who had not had a stem cell transplant. Furthermore these was a suggestion that there is an increased risk in patients who had taken low dose melphalan and prednisone orally and also in patients who have never taken melphalan in any form. This new information strongly suggests that simply having myeloma confers some risk of these two hematologic cancers and that the risk is both treatment related (melphalan) and non-treatment related (environmental, genetic etc). The increased risk was calculated to be 11- fold.