Peripheral blood parameter abnormalities precede therapy‐related myeloid neoplasms after autologous transplantation for lymphoma.

Background: Therapy‐related myeloid neoplasms (t‐MN) are a leading cause of nonrelapse mortality after autologous peripheral blood stem cell transplantation (aPBSCT) in patients with Hodgkin lymphoma (HL) and non‐Hodgkin lymphomas (NHL). t‐MN patients treated at an earlier stage of disease evolution have a better prognosis, and this presents a need to identify patients at risk for t‐MN. Methods: Using a prospective longitudinal study design, this study evaluated peripheral blood parameters pre‐aPBSCT and on day 100, at 6 months, 1 year, 2 years, and 3 years in 304 patients treated with aPBSCT. The relation between peripheral blood parameters and subsequent development of t‐MN was examined, and nomograms were developed to identify patients at risk for t‐MN. Results: Twenty‐one patients developed t‐MN at a median of 1.95 years post‐aPBSCT. Hemoglobin, hematocrit, white blood cell, and platelet counts were lower among patients who developed t‐MN compared to those who did not; these differences appeared soon after aPBSCT, persisted, and preceded development of t‐MN. Older age at aPBSCT (hazard ratio [HR]per_year_increase = 1.08, P =.007), exposure to total body irradiation (TBI) (HR = 2.90, P =.04), and low 100‐day platelet count (HRincrease_per_unit_decline_in_PLT = 1.01, P =.002) predicted subsequent t‐MN. These parameters and primary diagnosis allowed identification of patients at high risk of t‐MN (eg, an HL patient undergoing aPBSCT at the age of 70 years with TBI and with a day 100 PLT between 100,000 and 150,000 would have a 62% probability of developing t‐MN at 6 years post‐aPBSCT). Conclusions: Abnormalities in peripheral blood parameters can identify patients at high risk for t‐MN after aPBSCT for HL or NHL, allowing opportunities to personalize close surveillance and possible disease‐modifying interventions. In this longitudinal study of patients with lymphoma treated with autologous peripheral blood stem cell transplantation, blood parameters are altered among patients who subsequently develop therapy‐related leukemia in comparison with those who do not. These differences appear soon after transplantation, persist, and precede the development of therapy‐related myeloid neoplasms. This allows the identification of those at high risk for therapy‐related leukemia and provides opportunities to personalize close surveillance and possible disease‐modifying interventions among those at highest risk. [ABSTRACT FROM AUTHOR]