大剂量化疗作为乳腺癌患者辅助治疗后继发性骨髓发育异常和急性髓系白血病的低发病率：欧洲血液和骨髓移植组实体瘤工作组的一项研究

Low incidence of secondary myelodysplasia and acute myeloid leukemia after high-dose chemotherapy as adjuvant therapy for breast cancer patients: a study by the Solid Tumors Working Party of the European Group for Blood and Marrow Transplantation.

作者信息

Kröger N, Zander A R, Martinelli G, Ferrante P, Moraleda J M, Da Prada G A, Demirer T, Socie G, Rosti G

机构信息

Department of Bone Marrow Transplantation, University Hospital Hamburg, Germany.

出版信息

Ann Oncol. 2003 Apr;14(4):554-8. doi: 10.1093/annonc/mdg161.

DOI:10.1093/annonc/mdg161

PMID:12649100

Abstract

BACKGROUND

To determine the incidence of secondary myelodysplasia (sMDS) or acute myeloid leukemia (AML) in node-positive breast cancer patients who received high-dose chemotherapy (HDCT) followed by autologous stem-cell support as adjuvant therapy.

PATIENTS AND METHODS

The incidence of sMDS/AML was retrospectively assessed in 364 node-positive breast cancer patients who received HDCT followed by autologous stem-cell support as adjuvant therapy between November 1989 and December 1997 and were reported to the European Group for Blood and Marrow Transplantation registry.

RESULTS

The median age of the patients was 45 years (range 22-62 years). Two hundred and ninety-one patients received peripheral blood stem cells and 55 patients received autologous bone marrow as stem-cell support. The most frequently used conditioning regimen was the STAMP-V regimen (32%), followed by melphalan-thiotepa (22%) and melphalan-mitoxantrone-cyclophosphamide (21%). The 5-year probability of overall survival is 71% (95% CI 65% to 77%). After a median follow-up of 48 months (range 1-108 months) only one case of AML was observed, resulting in a crude incidence of 0.27%. This case of AML was observed 18 months after HDCT consisting of three cycles of epirubicin and cyclophosphamide with a cumulative dose of epirubicin 960 mg and cyclophosphamide 19 g. The French-American-British type of AML was M4, and the cytogenetic analysis showed a translocation t(9;11)(p22;q23). After complete remission following high-dose cytarabine and idarubicin the patient relapsed and died.

CONCLUSIONS

In contrast to patients with malignant lymphoma there seems to be no increased risk of sMDS/AML after HDCT in breast cancer. Continued monitoring is required to confirm this low incidence after a longer follow-up period.

摘要

背景

确定接受高剂量化疗（HDCT）并随后接受自体干细胞支持作为辅助治疗的淋巴结阳性乳腺癌患者中继发性骨髓增生异常综合征（sMDS）或急性髓系白血病（AML）的发生率。

患者与方法

对1989年11月至1997年12月期间接受HDCT并随后接受自体干细胞支持作为辅助治疗且已向欧洲血液和骨髓移植登记处报告的364例淋巴结阳性乳腺癌患者中sMDS/AML的发生率进行回顾性评估。

结果

患者的中位年龄为45岁（范围22 - 62岁）。291例患者接受外周血干细胞，55例患者接受自体骨髓作为干细胞支持。最常用的预处理方案是STAMP - V方案（32%），其次是美法仑 - 噻替派（22%）和美法仑 - 米托蒽醌 - 环磷酰胺（21%）。总生存的5年概率为71%（95%可信区间65%至77%）。中位随访48个月（范围1 - 108个月）后仅观察到1例AML，粗发病率为0.27%。该例AML在由三个周期表柔比星和环磷酰胺组成的HDCT后18个月观察到，表柔比星累积剂量为960 mg，环磷酰胺累积剂量为19 g。该AML的法美英分型为M4，细胞遗传学分析显示有t(9;11)(p22;q23)易位。在接受大剂量阿糖胞苷和伊达比星治疗完全缓解后患者复发并死亡。