Ogasawara Toshie, Yasuyama Masako, Kawauchi Kiyotaka
Tokyo Women's Medical University Daini Hospital, Department of Medicine, Tokyo 116-8567, Japan.
Am J Hematol. 2005 Jun;79(2):136-41. doi: 10.1002/ajh.20329.
We describe a patient who developed myelodysplastic syndrome over 2 years after achieving complete remission of acute myeloid leukemia (AML). The patient was treated in July 1998 with anthracycline, etoposide, and behenoyl cytarabine chemotherapy for AML (French-American-British classification, M2; World Health Organization classification, AML with maturation) and achieved complete remission. At presentation, no chromosomal abnormalities were detected. In December 2000, the patient's peripheral blood revealed pancytopenia, and his bone marrow was hypocellular with trilineage myelodysplasia and no blasts. Chromosomal analysis revealed complex karyotypic abnormalities, including monosomy 5. The patient was diagnosed with high-grade myelodysplastic syndrome (MDS)/refractory anemia with excess blasts (RAEB) subtype. The pancytopenia progressed rapidly, and he died 2 months after the diagnosis of MDS. Therapy-related MDS and AML (t-MDS/t-AML) developing after treatment for acute leukemia is unusual; the primary leukemia associated with most cases of t-MDS/t-AML is acute promyelocytic leukemia (APL). This unusual case suggests that AML excluding APL should be considered a primary hematologic malignancy for t-MDS/t-AML.
我们描述了一名患者，该患者在急性髓系白血病（AML）完全缓解2年多后发生了骨髓增生异常综合征。该患者于1998年7月接受了蒽环类药物、依托泊苷和山嵛酰阿糖胞苷化疗以治疗AML（法美英分类，M2；世界卫生组织分类，伴有成熟的AML），并实现了完全缓解。初诊时，未检测到染色体异常。2000年12月，患者外周血出现全血细胞减少，其骨髓细胞减少，伴有三系骨髓发育异常且无原始细胞。染色体分析显示复杂的核型异常，包括5号染色体单体。该患者被诊断为高危骨髓增生异常综合征（MDS）/伴过多原始细胞的难治性贫血（RAEB）亚型。全血细胞减少迅速进展，患者在诊断为MDS后2个月死亡。急性白血病治疗后发生的治疗相关MDS和AML（t-MDS/t-AML）并不常见；与大多数t-MDS/t-AML病例相关的原发性白血病是急性早幼粒细胞白血病（APL）。这个不寻常的病例表明，除APL外的AML应被视为t-MDS/t-AML的原发性血液系统恶性肿瘤。
