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CIBMTR is a research collaboration between the NMDP/Be The Match and Medical College of Wisconsin.
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AML & MDS Subtype Reporting on the Pre-TED
Patients may develop AML or MDS secondary to therapy for another malignancy (e.g., Hodgkin Lymphoma). In other cases, patients with an underlying MDS may transform to AML. To report the appropriate disease and subtype, determine:
- If the patient had a history of multiple malignancies (e.g., HL, MDS, & AML with myelodysplasia related changes). What was the timing of the diagnoses? In other words, when were each of the malignancies diagnosed?
- What treatment did the patient receive for the prior malignancy?
Therapy-related myeloid neoplasms (i.e., MDS or AML) are usually caused by cytotoxic therapy. The most common agents include alkylating agents (e.g., melphalan, cytoxan, thiotepa, etc.), topoisomerase II inhibitors (e.g., etoposide, doxorubicin, etc.) and/or radiation therapy. If the patient was exposed to any of these cytotoxic agents, then a therapy related subtype is likely (e.g., therapy related AML).
If the patient wasn't given any of the above mentioned agents to treat a prior malignancy and is now diagnosed with AML, then it's unlikely the patient has a therapy related AML.
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Question: When we harvest stem cells after cycle two (which includes Cytoxan as an agent) should we count this as priming with Cytoxan for the collection of PBSC, as well as, the high dose neupogen? Answer: It depends on when the patient's counts recovered and the timing of the PBSC collection.
If the patient's counts recovered following cycle #2 (containing Cytoxan), prior to receiving the high dose neupogen for the PBSC collection, then cycle #2 would not count as priming. However, if the patient received the high dose neupogen immediately following the cycle containing Cytoxan, and then the PBSC were collected, as the WBC count recovered, then cycle #2 should be counted as priming.
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