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C Aul

Publications and source records attributed to C Aul.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Clinical course, morphology and prognosis of chronic myelomonocytic leukemia].

BACKGROUND: The FAB group proposed to distinguish 2 subgroups of chronic myelomonocytic leukemia (CMML): Depending on the total leukocyte count a myelodysplastic type (< 13,000/microliter) was separated from a myeloproliferative type (> 13,000/microliter). Prognostic factors are not well-established until now. PATIENTS AND METHODS: Based on retrospective analyses of patients with CMML diagnosed at our institution, we compared the presenting clinical and hematological features of both disorders and examined the natural course of the disease and prognostic factors. RESULTS: Out of 225 patients with CMML there were 115 patients with myelodysplastic type (MDS-CMML) and 110 patients with myeloproliferative type (MPD-CMML). Median age of patients at diagnosis and sex ratio were not different. Splenomegaly and hepatomegaly were more common in MPD-CMML. With regard to laboratory findings, patients with MPD-CMML presented with significantly higher LDH values. Except for WBC, peripheral blood counts were not different. Median percentage of bone marrow blasts was 8% in both disorders. Signs of bone marrow dysplasia were comparable in both disorders. Cumulative survival rates were similar in both disorders. Five years after diagnosis, actuarial survival for patients with MPD-CMML was 24%, as compared to 15% for patients with MDS-CMML. The probability of transformation to AML was higher in MDS-CMML (29% vs 18% after 5 years). Elevated LDH values, low hemoglobin values and male sex were independent risk factors for the entire group and for the MDS-CMML group. Using the Düsseldorf score, we could define risk groups within MDS-CMML with a median survial of 12 vs 40 months (p = 0.00005). Prognostic factors could not define risk groups within the MPD-CMML group. CONCLUSIONS: In summary, these data suggest that MDS-CMML and MPD-CMML are clinically distinguishing conditions, but the separation provides little prognostic information. The Düsseldorf score can be used to provide risk stratification in CMML.

Adult↗
PubMed1999

Congenital asplenia detected in a 60 year old patient with septicemia.

A 60 year-old female who had never been seriously ill, was brought to the emergency ward after she had been found somnolent at home. She developed renal failure, meningitis, respiratory distress and disseminated intravascular coagulation. Overwhelming septicemia was evident, and streptococcus pneumoniae was isolated from blood and cerebrospinal fluid. Surprisingly, peripheral blood smears showed numerous Howell-Jolly-bodies, indicating severe impairment of splenic function. On abdominal ultrasound, CT-scan, and scintigraphy no spleen could be detected. There was no history of abdominal surgery. Apparently, congenital asplenia, which was not noticed until the age of 60, was responsible for the patient's life-threatening septicemia. We suggest that, in cases of severe septicemia, the examination of a blood smear is useful to detect functional (or congenital) asplenia.

Bacteremia↗
PubMed1999

Double induction strategy for acute myeloid leukemia: the effect of high-dose cytarabine with mitoxantrone instead of standard-dose cytarabine with daunorubicin and 6-thioguanine: a randomized trial by the German AML Cooperative Group.

Early intensification of chemotherapy with high-dose cytarabine either in the postremission or remission induction phase has recently been shown to improve long-term relapse-free survival (RFS) in patients with acute myeloid leukemia (AML). Comparable results have been produced with the double induction strategy. The present trial evaluated the contribution of high-dose versus standard-dose cytarabine to this strategy. Between March 1985 and November 1992, 725 eligible patients 16 to 60 years of age with newly diagnosed primary AML entered the trial. Before treatment started, patients were randomized between two versions of double induction: 2 courses of standard-dose cytarabine (ara-C) with daunorubicin and 6-thioguanine (TAD) were compared with 1 course of TAD followed by high-dose cytarabine (3 g/m2 every 12 hours for 6 times) with mitoxantrone (HAM). Second courses started on day 21 before remission criteria were reached, regardless of the presence or absence of blast cells in the bone marrow. Patients in remission received consolidation by TAD and monthly maintenance with reduced TAD courses for 3 years. The complete remission (CR) rate in the TAD-TAD compared with the TAD-HAM arm was 65% versus 71% (not significant [NS]), and the early and hypoplastic death rate was 18% versus 14% (NS). The corresponding RFS after 5 years was 29% versus 35% (NS). An explorative analysis identified a subgroup of 286 patients with a poor prognosis representing 39% of the entire population; they included patients with more than 40% residual blasts in the day-16 bone marrow, patients with unfavorable karyotype, and those with high levels of serum lactate dehydrogenase. Their CR rate was 65% versus 49% (p =.004) in favor of TAD-HAM and was associated with a superior event-free survival (median, 7 v 3 months; 5 years, 17% v 12%; P =.012) and overall survival (median, 13 v 8 months; 5 years, 24% v 18%; P =.009). This suggests that the incorporation of high-dose cytarabine with mitoxantrone may contribute a specific benefit to poor-risk patients that, however, requires further substantiation. Double induction, followed by consolidation and maintenance, proved a safe and effective strategy and a new way of delivering early intensification treatment for AML.

Adolescent↗
PubMed1999

[Role of aggressive treatment strategies for myelodysplastic syndromes].

Myelodysplastic syndromes (MDS) constitute a heterogenous group of acquired bone marrow disorders characterized by ineffective hematopoiesis, cellular dysfunction and an increased risk of transformation into acute myeloid leukemia (AML). The percentage of medullary blast cells and the karyotype at diagnosis are the most important predictors of survival. Patients with more than 10% blast cells or an unfavourable karyotype (chromosome 7 abnormalities or complex aberrations) usually survive less than 12 months. This review article focuses on the roles of intensive AML-type chemotherapy, autologous stem cell transplantation and allogeneic bone marrow transplantation in the management of patients with advanced MDS. Recent studies suggest that, with appropriate selection of patients, intensive chemotherapy produces high rates of complete remission. Chances of entering remission are particularly high in patients with a good Karnofsky score, bone marrow blast count < 30% and normal karyotype. When compared with acute myeloid leukemia, results of autologous bone marrow transplantation in MDS are disappointing. A major disadvantage of this approach is the delayed recovery of hematopoiesis. Autologous peripheral blood progenitor cell transplantation overcomes this difficulty and is currently explored as consolidation therapy after successful remission induction with polychemotherapy in an intergroup study of the EORTC and EBMT. Allogeneic bone marrow transplantation remains the treatment of choice for younger MDS patients, offering a good chance of cure if the transplantation is performed at an early stage of disease or if the patient receives the transplant in complete remission after conventional chemotherapy.

Humans↗
PubMed1999

Pseudomonas aeruginosa orbital phlegmon in a patient treated for myelodysplastic syndrome with concomitant Sjögren's syndrome.

Pseudomonas aeruginosa orbital infections have been described very rarely in patients with neutropenia after chemotherapy. We report the case of a woman with the unusual association of Sjögren's disease and myelodysplasia, who suffered from a Pseudomonas aeruginosa orbital phlegmon after chemotherapy for her myelodysplastic syndrome. Partial intestinal antibiotic decontamination with ciprofloxacine did not prevent the infection. She was treated successfully with intravenous ceftazidime, netilmicin and granulocyte-colony stimulating factor (G-CSF). The normalization of the granulocyte count seems to play a crucial role for recovery. We present the clinical and radiological findings, discuss the therapy and review the literature concerning ocular infections due to Pseudomonas. Other infections due to this germ in immunocompromised hosts are briefly reviewed.

Aged↗
PubMed1999

Factors influencing G-CSF-mediated mobilization of hematopoietic progenitor cells during steady-state hematopoiesis in patients with malignant lymphoma and multiple myeloma.

We retrospectively analyzed factors influencing PBPC mobilization during steady-state hematopoiesis in 52 patients with malignant lymphoma (n=35) or multiple myeloma (n=17) who received 77 cycles of G-CSF (12.5-50 microg G-CSF/kg/day). For 15 of these patients, the first mobilization cycle (12.5 microg G-CSF/kg/day) was followed by a second course with an increased dose of G-CSF (25 or 50 microg/kg/day). Leukapheresis was started on day 4, about 2 h after s.c. G-CSF administration, and repeated on 2-5 consecutive days. CD34+ cells were determined by flow cytometry in each apheresis product and in the peripheral blood prior to G-CSF administration, beginning on day 4. Colony assays were performed on cryopreserved samples prior to autografting. In the 15 patients receiving two mobilization cycles the higher G-CSF dose was associated with higher levels of CD34+ cells, a higher mean yield of CD34+ cells per apheresis (p<0.05), and a higher percentage of successful (>2x10(6) CD34+ cells/kg) collections (p=0.058). Patients with limited previous cytotoxic therapy (n=19, up to six cycles of a standard regimen such as CHOP and/or less than 20% marrow irradiation) who received a daily dose of 12.5 microg G-CSF/kg had higher levels of circulating CD34+ cells, a higher mean yield of CD34+ cells per apheresis (p<0.05), and a higher percentage of successful collections (p<0.05) compared with patients previously treated with more intensive radiochemotherapy (n=15). Ten of 20 patients (50%) who failed during the first cycle were successful during subsequent cycles with escalated doses of G-CSF. Trough levels of circulating CD34+ cells on day 4 were predictive for success or failure to achieve >2x10(6) CD34+ cells/kg, especially in heavily pretreated patients. In conclusion, a daily dose of 12.5 microg G-CSF/kg seems sufficient to mobilize PBPC during steady-state hematopoiesis in the majority of patients who have received limited previous radiochemotherapy. Higher doses of G-CSF, up to 50 microg/kg/day, mobilize more PBPC and should be considered for patients previously treated with intensive radiochemotherapy or those failing to mobilize sufficient numbers of CD34+ cells with lower doses of G-CSF.

Adult↗
PubMed1999

[Pneumococcal septicemia in functional asplenia: first manifestation of systemic autoimmune disease?].

A 35 year old female was admitted into the hospital because of rapid onset fever and chills. Streptococcus pneumoniae could be isolated from blood as the responsible pathogen for septicemia. Necroses of fingers and feet occurred. The clinical signs of an overwhelming post-splenectomy infection (OPSI) were evident. High-dose penicillin was administered and the patient recovered. Howell-Jolly-bodies were seen in peripheral blood smears. A spleen within normal size could be demonstrated in CT and sonography. Angiologic findings showed intact splenic arteries and a normal vein, whereas the small splenic vessels were rare. MRT of the spleen using Endorem (Fe), showed only a minimal uptake of the RES. In a scintigram of spleen and liver using 320 MBq Tc-99m nanokoll, the spleen was not visible. Thus, functional asplenia was demonstrated by Howell-Jolly-Bodies and by image methods. An increased antinuclear antibody level and a Sm-antibody lead to the diagnosis of undifferentiated connective tissue disease. As far as we know this is the first case that functional asplenia was the first symptom of a systemic autoimmune disease.

Adult↗
PubMed1999

Results of a randomized double-blind placebo-controlled trial evaluating sequential high-dose cytosine arabinoside/mitoxantrone chemotherapy with or without granulocyte/macrophage-colony-stimulating factor in high-risk myelodysplastic syndromes.

A prospective, randomized, double-blind placebo-controlled trial was designed to evaluate the impact of granulocyte/macrophage-colony-stimulating factor (GM-CSF) on the efficacy of sequential high-dose cytosine arabinoside/mitoxantrone chemotherapy (S-HAM) in adult patients with high-risk myelodysplastic syndromes (MDS). GM-CSF or placebo was given subcutaneously once daily at a dose of 250 microg/m2, starting 48 h prior to chemotherapy, and continued until neutrophil recovery. Owing to high toxicity and slow patient recruitement the study was closed and unblinded after 31 patients had been enrolled; 15 were randomized to receive placebo and 16 to receive GM-CSF. A total of 29 patients were evaluable for response; their median age was 57 years. Ten patients achieved a complete remission (34.5%), 9 patients had persistent MDS (31%), 10 patients died within 6 weeks after the onset of treatment (early death) (34.5%). The median remission duration was 190 days (range: 2.5-45 months). Among the 29 evaluable patients no significant differences could be found between the two study arms regarding complete remission rate [GM-CSF: 31% (5/16) versus placebo: 38% (5/13) P = 0.45], rate of persistent MDS [GM-CSF: 25% (4/16) versus 38% (5/13) P = 0.35), early death rate [44% (7/16) versus 23% (3/13) P = 0.22] and remission duration (GM-CSF: 87 days versus placebo 221 days). Duration of granulocytopenia (median: 33 days with GM-CSF) versus 35 days with placebo) and frequency of infectious episodes were not significantly influenced by GM-CSF. The small number of patients finally analyzed means that no definite conclusions about the effect of GM-CSF can be reached.

Adult↗
PubMed1998

Adenosine is worth trying in patients with paroxysmal supraventricular tachycardia on chronic theophylline medication.

Adenosine is widely used to terminate paroxysmal supraventricular tachycardia. However, it is usually considered of no value in patients on theophylline, for methylxanthines completely antagonize the A(1) -receptor mediated negative dromotropic adenosine effect. We report a case of a 69 year old man who had chronic obstructive lung disease and spontaneous pneumothorax. Supraventricular tachycardia with a heart rate of 200 bpm persisted even after a pleural drain was inserted and the lung became fully inflated. Although the patient was on theophylline medication with effective serum plasma levels, adenosine terminated the supraventricular tachycardia after three repeated doses of 3, 6 and 9 mg, respectively. This observation further nourishes previous hypotheses that chronic administration of an A1-receptor antagonist leads to up-regulation of the adenosine receptor number.

Adenosine↗
PubMed1998

[High-dose chemotherapy of patients with multiple myeloma].

For patients younger than 60 years with multiple myeloma in a stage requiring chemotherapy high dose chemotherapy followed by autologous blood stem cell transplantation appears to be the best therapeutic option. Conditioning regimens resulting in a high proportion of patients with 90% tumor reduction (very good partial or complete remissions) should be preferred. A good quality of remission is a prerequisite for prolonging the disease free survival. World-wide the tandem high dose melphalan protocol developed by Barlogie and coworkers is deemed the most effective conditioning regimen. A pilot study in our clinic with an intensified high dose regimen combining idarubicin, melphalan and cyclophosphamide showed similar remission rates. The application of peripheral blood stem cells reduces the treatment related mortality to less than 10%. It is expected that more than 50% of patients treated with high dose chemotherapy and autologous peripheral blood stem cell transplantation will survive at least 5 years. Therefore, the prognosis of such patients is significantly improved compared with patients treated with conventional chemotherapy. Treatment related mortality after allogeneic blood stem cell transplantation is about 40%. Therefore, during the first 2 to 3 years after transplantation the prognosis of patients after allogeneic transplantation is inferior to that of patients receiving autologous transplants. Subsequently, patients with allogeneic transplants do better, because the relapse rate after allogeneic transplantation is decreased and some patients may achieve long term remissions or even cures. Therefore, we recommend allogneic blood stem cell transplantation for patients younger than 50 years if an HLA-identical sibling donor is available and there are no contraindications. For patients older than 60 years the Alexanian protocol is still the therapeutic standard. On the other hand, successful application of high dose chemotherapy and autologous blood stem cell transplantation in patients of this age group has been reported. Therefore, clinical trials are required to clarify whether the prognosis of patients older than 60 years can be improved with treatment strategies including high dose chemotherapy.

Adult↗
PubMed1998

Granulocyte colony-stimulating factor (G-CSF) mediated mobilization of leukemic cells in Philadelphia chromosome positive acute lymphoblastic leukemia expressing myeloid antigens (my+Ph+ALL).

The therapeutic benefit of G-CSF in the treatment of acute lymphoblastic leukemia has been well established. G-CSF has been used to shorten neutropenia induced by conventional dose cytotoxic chemotherapy and allogeneic bone marrow transplantation. Recently autologous peripheral blood progenitor cell transplantation has been explored to treat high-risk ALL. Several in vitro studies suggest that subpopulations of lymphoblasts express G-CSF receptors. Furthermore, enhanced growth of Ph+ ALL cells expressing myeloid antigens stimulated by G-CSF has been demonstrated in vitro. However, the clinical relevance of these findings has been questioned. We report a patient with my+Ph+ALL in whom the administration of G-CSF after high-dose Cytarabin and Mitoxantrone led to a significant mobilization of leukemic cells and contamination of the stem cell harvest during cytologic marrow remission.

Adult↗
PubMed1998

Pleural carcinosis confirmed by adjuvant cytological methods: a case report.

We describe a case of a 43-yr-old woman presenting a progressive pleural effusion. The patient was known to have an acute myeloid leukemia in complete remission after allogenic bone marrow transplantation. Suspicion of pleural carcinosis was raised cytologically and confirmed by immunocytochemistry, DNA-cytometry, and atomic force microscopy. We emphasize the use of these additional methods for the distinction of adenocarcinoma cells in effusions from reactive mesothelial cells.

Acute Disease↗
PubMed1998

Granulocyte colony-stimulating factor shortens duration of critical neutropenia and prolongs disease-free survival after sequential high-dose cytosine arabinoside and mitoxantrone (S-HAM) salvage therapy for refractory and relapsed acute myeloid leukemia. German AML Cooperative Group.

Patients with primary refractory or relapsed acute myeloid leukemia (AML) who undergo intensive salvage chemotherapy carry a high risk of treatment failure due to infectious complications and early relapses. The study presented here assessed the effect of granulocyte colony-stimulating factor (G-CSF) on the duration of post-treatment neutropenia, the incidence of infection-related deaths, and the disease-free and overall survival. Sixty-eight evaluable patients with relapsed and refractory AML received G-CSF 5 microg/kg per day subcutaneously starting 2 days after the completion of salvage treatment with the S-HAM regimen, consisting of high-dose cytosine arabinoside twice daily on days 1, 2, 8, and 9 and mitoxantrone on days 3, 4, 10, and 11. Ninety-one patients who were treated with the identical S-HAM regimen but without G-CSF support during a preceding study served as controls. The application of G-CSF resulted in a significant shortening of critical neutropenia of less than 500 microl (36 vs. 40 days; p = 0.008), which translated into a trend towards a lower early death rate (21% vs. 30%) and an increase of complete remissions (56% vs. 47%, p=0.11). In patients younger than 60 years a significant prolongation of time to treatment failure (159 vs. 93 days, p=0.038) and of duration of disease-free survival (203 vs. 97 days, p=0.003) was observed. These results indicate a beneficial effect of G-CSF on early mortality as well as on long-term outcome when administered after S-HAM salvage therapy for advanced AML.

Acute Disease↗
PubMed1998

Effects of overshadowing on conditioned nausea in cancer patients: an experimental study.

The infusion of cytotoxic drugs in cancer patients is often accompanied by posttreatment nausea (PN). In addition, patients complain about nausea prior to an infusion [i.e., anticipatory nausea (AN)]. AN is mainly explained by classical conditioning, with the infusion as the unconditioned stimulus (US) and with the stimuli signaling the infusion as conditioned stimuli (CS). Despite this conditioning etiology, a specifically derived therapy to attenuate the CS-US contingency is missing. The purpose of this study is to develop and to test an overshadowing procedure for prevention of AN, and also for the modification of PN intensity. Sixteen cancer patients were assigned to one of two groups: Overshadowing+ (OV+) and Overshadowing- (OV-). At the start of all infusions of two consecutive chemotherapy cycles A and B (acquisition), OV+ subjects drank a saliently tasting beverage (the overshadowing CS), whereas group OV- drank water. All patients received water in cycle C (test). Self-reported symptoms and heart rates were recorded. As expected, in cycle C (test), no patient of group OV+ showed AN, whereas two patients of group OV- developed AN. There was a tendency for a reduction of the intensity of PN, in terms of duration and latency after overshadowing, in cycle C: OV+ patients tended to show a shorter duration and a longer latency between end of infusion and PN onset. In OV-, there was a significantly larger heart rate deceleration in both measurement periods, in the anticipatory and the posttreatment measurement period. Data suggest to apply overshadowing for prevention of AN and modification of PN. Physiological markers of conditioned nausea are revealed. After its procedural implementation, the technique can be used in larger samples now.

Antineoplastic Agents↗
PubMed1998

Increasing incidence of myelodysplastic syndromes: real or fictitious?

Over the past 10-20 years, there has been a growing interest in the myelodysplastic syndromes (MDS). Due to difficulties of diagnosis, classification and case recording, the epidemiological features of MDS are still poorly defined. Recently, a number of cancer registries have published data on the regional occurrence of MDS, suggesting that MDS are much more common than previously thought. The crude incidence of MDS in these studies was 3.5-12.6 per 100,000 population per year. In people over the age of 70 years, incidence rates varied between 15 and 50 per 100,000 per year. Contrary to the assumption of most hematologists, cancer surveys usually failed to demonstrate a rising incidence of MDS. In those studies showing a significant increase in MDS, the rising number of cases was probably due to increased physician awareness and extended use of invasive diagnostic procedures in elderly people. Differences in incidence figures between regional studies may be attributed to several causes, including regional variations in disease incidence, small and ill-defined reference populations, bias due to patient referral patterns, varying intensity of diagnostic procedures and different observation periods. Because of the paucity of clinical symptoms and insignificance of morphological bone marrow changes particularly in early stage MDS, the currently available incidence figures are likely to underestimate the true incidence of MDS. Large-scale epidemiological studies are required for obtaining truly representative statistics on the incidence and prevalence of the MDS. In industrialized countries, a dramatic increase in these disorders can be expected over the next few decades due to the 'greying' of the population.

Adult↗
PubMed1998

Problems in the classification of CMML--dysplastic versus proliferative type.

The FAB group proposed to distinguish two subgroups of chronic myelomonocytic leukemia (CMML). Depending on the total leukocyte count, a myelodysplastic type (MDS-CMML) (< or = 13,000 microl(-1)) was separated from a myeloproliferative type (MPD-CMML) (> 13,000 microl(-1)). Based on retrospective analyses of 158 patients with CMML, we compared the presenting clinical and hematological features of both disorders and examined whether the refined classification is important in terms of prognosis. There were 81 patients with MDS-CMML and 77 patients with MPD-CMML. Median age of patients at diagnosis (70 versus 72 years) was not different. The sex ratio showed a preponderance of males in the MPD group (m:f; 2.1:1). Splenomegaly was more common in MPD-CMML (54 versus 30%; P = 0.002). With regard to laboratory findings, patients with MPD-CMML presented with significantly higher LDH values (medians 295 versus 231 U ml(-1); P = 0.008) and higher serum deoxythymidine kinase levels (medians 150 versus 41 U microl(-1); P = 0.0025). Except for white blood cell count (WBC), peripheral blood counts were not different. Median percentage of bone marrow blasts was 9% and cumulative survival rates were similar in both disorders. Two years after diagnosis, actuarial survival for patients with MPD-CMML was 33%, as compared to 50% for patients with MDS-CMML (P = 0.31). The probability of transformation to AML was higher in MDS-CMML (32 versus 17% after 5 years), but this difference also did not reach statistical significance. The survival of patients with MDS-CMML was similar to that of other MDS patients (RAEB) who had corresponding medullary blast counts. Using the Düsseldorf-score, we could define two risk groups within MDS-CMML with a median survial of 12 versus 40 months (P = 0.001). None of the known scoring systems could define risk groups within the MPD-CMML group. In summary, these data suggest that MDS-CMML and MPD-CMML are clinically distinguishing conditions, but the separation provides little prognostic information. Further studies are needed to clarify whether response to therapy is different in MDS-CMML and MPD-CMML.

Adult↗
PubMed1998

Bone marrow transplantation from HLA-identical siblings as first-line treatment in patients with myelodysplastic syndromes: early transplantation is associated with improved outcome. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

Allogeneic bone marrow transplantation (BMT) offers a potential cure for younger patients with myelodysplastic syndromes (MDS) or secondary acute myeloid leukemia (sAML). More than 600 patients from 50 European centers have now been reported to the European Group for Blood and Marrow Transplantation (EBMT). We retrospectively analyzed 131 patients reported to the Chronic Leukemia Working Party of the EBMT who underwent BMT from HLA-identical siblings without prior remission induction chemotherapy. At the time of BMT 46 patients had refractory anemia (RA) or RA with ringed sideroblasts, 67 patients had more advanced MDS subtypes and 18 patients had progressed to sAML. The 5-year disease-free (DFS) and overall survival (OS) for the entire group of patients was 34 and 41%, respectively. Fifty patients died from transplant-related complications, most commonly graft-versus-host disease and/or infections. Relapse occurred in 28 patients between 1 and 33 months after BMT, resulting in an actuarial probability of relapse of 39% at 5 years. DFS and OS were dependent on pretransplant bone marrow blast counts. Patients with RA/RARS, RAEB, RAEB/T and sAML had a 5-year DFS of 52, 34, 19 and 26%, respectively. The 5-year OS for the respective patient groups was 57, 42, 24 and 28%. In a multivariate analysis, younger age, shorter disease duration, and absence of excess of blasts were associated with improved outcome. From these data we conclude that patients with myelodysplasia who have appropriate marrow donors, especially those aged less than 40 years and those with low medullary blast cell count should be treated with BMT as the primary treatment early in the course of their disease. Transplantation early after establishing the diagnosis of MDS may improve prognosis due to a lower treatment-related mortality and a lower relapse risk.

Adolescent↗