Park S, Brice P, Noguerra M E, Simon D, Rousselot P, Kerneis Y, Morel P, Marolleau J P, Gisselbrecht C
Services d'Hématologie, Hôpital Saint Louis, Paris, France.
Bone Marrow Transplant. 2000 Aug;26(3):321-6. doi: 10.1038/sj.bmt.1702510.
The incidence of secondary myelodysplastic syndromes and acute leukemia (MDS/AL) was reported for 395 patients autografted for Hodgkin's disease (HD) (n = 96) and non-Hodgkin's lymphoma (NHL) (n = 299) between 1987 and 1998. Eleven patients developed secondary MDS/AL (crude rate at 2.8%) including two lymphoblastic AL cases. The mean time of occurrence was at 32 months after autologous stem cell transplantation (ASCT) and 71 months after diagnosis. The estimated actuarial incidence at 10 years was at 6.3% (+/-4%). Karyotyping revealed complex chromosomal aberrations in only one patient, and two translocations [t(8;21) and t(8;16)]. No features of topoisomerase II inhibitor-related leukemia were found. Only one patient had received ASCT in first remission. The remaining 10 patients had received multiple courses of chemotherapy before stem cell collection and four had relapsed after ASCT and before the occurrence of secondary MDS/AL. Five of 11 patients had received localized radiotherapy and five others received TBI in their conditioning regimen. Ten patients died despite chemotherapy and/or supportive care and only one patient is alive and well after genoidentical allogeneic transplantation. We suggest a cumulative leukemogenic role of pre-ASCT radiation and chemotherapy in the occurrence of these secondary MDS/AL more than the high-dose therapy itself.
报告了1987年至1998年间395例接受自体造血干细胞移植治疗霍奇金淋巴瘤（HD）（n = 96）和非霍奇金淋巴瘤（NHL）（n = 299）患者的继发性骨髓增生异常综合征和急性白血病（MDS/AL）的发病率。11例患者发生继发性MDS/AL（粗发病率为2.8%），包括2例淋巴细胞性AL病例。发生的平均时间为自体干细胞移植（ASCT）后32个月和诊断后71个月。10年时的估计精算发病率为6.3%（±4%）。核型分析仅在1例患者中发现复杂的染色体畸变，以及两种易位[t(8;21)和t(8;16)]。未发现拓扑异构酶II抑制剂相关白血病的特征。仅1例患者在首次缓解期接受了ASCT。其余10例患者在干细胞采集前接受了多疗程化疗，4例在ASCT后且在继发性MDS/AL发生前复发。11例患者中有5例接受了局部放疗，另外5例在预处理方案中接受了全身照射。10例患者尽管接受了化疗和/或支持治疗仍死亡，仅1例患者在同基因异体移植后存活且状况良好。我们认为，ASCT前的放疗和化疗在这些继发性MDS/AL的发生中具有累积致白血病作用，其作用超过了高剂量治疗本身。
