Pedersen-Bjergaard J, Andersen M K, Christiansen D H
Section for Hematology/Oncology, Cytogenetic Laboratory, Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark.
Blood. 2000 Jun 1;95(11):3273-9.
Therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML) after high-dose chemotherapy (HD-CT) and autologous stem cell transplantation (ASCT) for malignant diseases have become an important problem. The actuarial risk has varied, but has often been high if compared to the risk after conventional therapy. Prior chemotherapy with large cumulative doses of alkylating agents is the most important risk factor. In addition, patient age and previous radiotherapy, particularly the use of total body irradiation (TBI) in the preparative regimen for ASCT, have been identified as risk factors. In 3 studies, patients transplanted with CD34(+ )cells from peripheral blood after chemotherapy priming showed a higher risk of t-MDS or t-AML than patients transplanted with cells isolated from the bone marrow without priming. To what extent this higher risk relates to the prior therapy with a different contamination with preleukemic, hematopoietic precursors of the CD34(+) cells obtained by the 2 methods, or is a direct result of chemotherapy priming, or of an increasing awareness of these complications, remains to be determined. The latent period from ASCT to t-MDS and t-AML has often been short, 12 months or less in 27% of the patients. Bone marrow pathology of early cases of t-MDS after ASCT has often been neither diagnostic nor prognostic, but most patients presented chromosome aberrations, primarily deletions or loss of the long arms of chromosomes 5 and 7. The prognosis was in general poor, although 17% with indolent t-MDS survived more than 18 months from diagnosis, and most of these presented a normal karyotype or a single chromosome aberration.
对于恶性疾病，在接受大剂量化疗（HD-CT）和自体干细胞移植（ASCT）后发生的治疗相关骨髓增生异常综合征（t-MDS）和急性髓系白血病（t-AML）已成为一个重要问题。实际风险各不相同，但与传统治疗后的风险相比通常较高。先前使用大累积剂量烷化剂进行化疗是最重要的风险因素。此外，患者年龄和先前的放疗，特别是在ASCT预处理方案中使用全身照射（TBI），也已被确定为风险因素。在3项研究中，化疗预处理后接受外周血CD34(+)细胞移植的患者比未进行预处理而接受从骨髓中分离细胞移植的患者发生t-MDS或t-AML的风险更高。这种较高的风险在多大程度上与先前治疗导致通过这两种方法获得的CD34(+)细胞中不同程度的白血病前期造血前体细胞污染有关，或是化疗预处理的直接结果，抑或是对这些并发症认识的提高所致，仍有待确定。从ASCT到t-MDS和t-AML的潜伏期通常较短，27%的患者在12个月或更短时间内发病。ASCT后早期t-MDS病例的骨髓病理学检查通常既无诊断价值也无预后价值，但大多数患者存在染色体畸变，主要是5号和7号染色体长臂的缺失或丢失。总体预后较差，尽管17%的惰性t-MDS患者自诊断后存活超过18个月，且其中大多数患者核型正常或仅有单一染色体畸变。
