Putzki Norman, Knipp Sabine, Ramczykowski Tim, Vago Susanne, Germing Ulrich, Diener H Chr, Limmroth Volker
Department of Neurology, University Hospital Essen, Essen, Germany.
Mult Scler. 2006 Jun;12(3):363-6. doi: 10.1191/135248506ms1307cr.
Azathioprine (Aza) is a widely used immunosuppressive drug in multiple sclerosis (MS) treatment. Recently, the incidence of secondary myelodysplastic syndromes (sMDS) associated with a poor prognosis was found to be elevated in patients treated with Aza for non-malign disorders. Three hundred and seventeen MS patients were retrospectively analysed and complete blood counts were examined for those exposed to Aza. We identified one case of sMDS (cumulative dose 627 g) in a young patient and two further malignancies (cumulative doses 27 g and 54 g) in the Aza group (n = 81; 3.7%). In the non-Aza (n = 236) group, five malignancies (2.1%, P = 0.419) were identified. Including our patient, four cases of sMDS after long-term Aza therapy in MS have been reported so far. Cases suggest a time- and dose-dependent risk of sMDS in long-term therapy of MS with Aza. Long-term Aza therapy needs careful monitoring.
硫唑嘌呤（Aza）是多发性硬化症（MS）治疗中广泛使用的免疫抑制药物。最近发现，接受Aza治疗非恶性疾病的患者中，与预后不良相关的继发性骨髓增生异常综合征（sMDS）的发病率有所升高。对317例MS患者进行了回顾性分析，并对接受Aza治疗的患者进行了全血细胞计数检查。我们在Aza组（n = 81；3.7%）的一名年轻患者中发现了1例sMDS（累积剂量627 g），另外还发现了2例其他恶性肿瘤（累积剂量分别为27 g和54 g）。在非Aza组（n = 236）中，发现了5例恶性肿瘤（2.1%，P = 0.419）。包括我们的患者在内，迄今为止已报道了4例MS患者长期接受Aza治疗后发生sMDS的病例。这些病例表明，MS患者长期使用Aza治疗存在sMDS的时间和剂量依赖性风险。长期使用Aza治疗需要仔细监测。
