Researchers from the City of Hope National Medical Center have reported that hematopoietic stem cell transplantation is effective therapy for women with acute leukemia or myelodysplasia following adjuvant chemotherapy for breast cancer. The details of this study appeared in an early online publication in the Annals of Oncology on June 29, 2009.
Patients with breast cancer receiving adjuvant chemotherapy and radiation therapy have an approximate 1% risk of developing myelodysplasia, which usually progresses to acute myeloid leukemia (AML). Although complete remissions can be achieved in 50% or more of patients with therapy-related AML, long-term survival is poor. In therapy-related AML, the only modality associated with cures is allogeneic stem cell transplantation, which has been associated with a cure rate of 20% or more. Recent studies suggest that a higher fraction of younger patients with secondary AML can be cured with an allogeneic stem cell transplantation, but there are few studies to document this. It has been observed that patients with secondary AML who do not achieve a complete remission with chemotherapy are rarely cured with an allogeneic stem cell transplant.
The current study looked at the outcomes of 15 women referred for treatment of secondary AML (n=14) or myelodysplsia (n=1) following adjuvant therapy for breast cancer. Ten of the patients had developed AML or myelodysplasia within two years of treatment. Eight of 15 patients had mixed-lineage leukemia, but other cytogenetic abnormalities were detected. Eleven patients underwent an allogeneic stem cell transplant, and one received an autologous transplant. Eleven of the 12 patients who underwent a stem cell transplant were in remission at a median follow-up of 20 months. These authors concluded that early consideration of a hematopoietic stem cell transplant in secondary AML and myelodysplasia in women with breast cancer was indicated.
Comments: This study suggests that there continues to be improvement in the results of stem cell transplants for secondary leukemia and myelodysplasia.
 Pullarkat V, Slovak ML, Dagis A, et al. Acute leukemia and myelodysplasia after adjuvant chemotherapy for breast cancer: durable remissions after hematopoietic stem cell transplantation. Annals of Oncology [early online publication]. June 29, 2009.