Abstract
Background:
Secondary myeloid
neoplasms comprise a group of
diseases arising after
chemotherapy,
radiation,
immunosuppressive therapy or from
aplastic anemia. Few studies have addressed
prognostic factors in these
neoplasms.
Method:
Forty-two
patients diagnosed from 1987 to 2008 with
secondary myeloid
neoplasms were retrospectively evaluated concerning clinical, biochemical, peripheral
blood,
bone marrow aspirate,
biopsy, and
immunohistochemistry and
cytogenetic features at
diagnosis as
prognostic factors. The International Prognostic Scoring System was applied.
Statistical analysis employed the Kaplan–Meier
method, log-rank and Fisher's exact test.
Results:
Twenty-three
patients (54.8%) were
male and the median age was 53.5 years (range 4–88 years) at
diagnosis of
secondary myeloid
neoplasms. Previous
diseases included
hematologic malignancies, solid
tumors,
aplastic anemia,
autoimmune diseases and conditions requiring solid
organ transplantations. One third of
patients (33%) were submitted to
chemotherapy alone, 2% to
radiotherapy, 26% to both modalities and 28% to
immunosuppressive agents. Five
patients (11.9%) had undergone autologous
hematopoietic stem cell transplantation. The median latency between the primary
disease and
secondary myeloid
neoplasms was 85 months (range 23–221 months). Eight
patients were submitted to allogeneic
hematopoietic stem cell transplantation to treat
secondary myeloid
neoplasms. Important changes in
bone marrow were detected mainly by
biopsy,
immunohistochemistry and
cytogenetics. The presence of clusters of CD117+
cells and p53+
cells were associated with low
survival. p53 was associated to a higher
risk according to the International Prognostic Scoring System. High
prevalence of clonal
abnormalities (84.3%) and
thrombocytopenia (78.6%) were independent factors for poor
survival.
Conclusion:
This study demonstrated that
cytogenetics,
bone marrow biopsy and
immunohistochemistry are very important prognostic tools in
secondary myeloid
neoplasms.