Kröger N, Damon L, Zander A R, Wandt H, Derigs G, Ferrante P, Demirer T, Rosti G
Department of Bone Marrow Transplantation, University of Hamburg, Hamburg, Germany.
Bone Marrow Transplant. 2003 Dec;32(12):1153-7. doi: 10.1038/sj.bmt.1704291.
The incidence of secondary myelodysplasia/acute myeloid leukemia (AML) was retrospectively assessed in an international joint study in 305 node-positive breast cancer patients, who received mitoxantrone-based high-dose chemotherapy (HDCT) followed by autologous stem cell support as adjuvant therapy. The median age of the patients was 57 years (range 22-67). In all, 268 patients received peripheral blood stem cells, and 47 patients received autologous bone marrow. After a median follow-up of 57 months (range 10-125), three cases of secondary AML (sAML) were observed, resulting in a cumulative incidence of 0.94%. One case of sAML developed 18 months after HDCT (FAB M3) The karyotype was translocation 15;17 and, after induction therapy, the patient underwent autologous stem cell transplantation, and is in complete remission (CR) of both breast cancer and AML. The second patient developed AML (FAB M4eo with inversion 16) 5 months after HDCT. This patient achieved CR after induction therapy, but died of infectious complication. A third patient developed AML (FAB M4) 6 months after HDCT. She achieved CR after induction therapy, but relapsed and expired 28 months after diagnosis of AML. sAML after mitoxantrone-based HDCT is a possible, but rare complication in breast cancer patients.
在一项国际联合研究中，对305例淋巴结阳性乳腺癌患者进行了回顾性评估，这些患者接受了以米托蒽醌为基础的大剂量化疗（HDCT），随后接受自体干细胞支持作为辅助治疗。患者的中位年龄为57岁（范围22 - 67岁）。共有268例患者接受了外周血干细胞，47例患者接受了自体骨髓。中位随访57个月（范围10 - 125个月）后，观察到3例继发性急性髓系白血病（sAML），累积发病率为0.94%。1例sAML在HDCT后18个月发生（FAB M3），核型为15;17易位，诱导治疗后，患者接受了自体干细胞移植，目前乳腺癌和AML均处于完全缓解（CR）状态。第二例患者在HDCT后5个月发生AML（FAB M4eo伴16号染色体倒位）。该患者诱导治疗后达到CR，但死于感染性并发症。第三例患者在HDCT后6个月发生AML（FAB M4）。她诱导治疗后达到CR，但在AML诊断后28个月复发并死亡。基于米托蒽醌的HDCT后发生sAML是乳腺癌患者可能出现但罕见的并发症。
