Division of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi Ward, Tokyo, Japan.
Int J Hematol. 2010 Apr;91(3):530-3. doi: 10.1007/s12185-010-0511-2. Epub 2010 Feb 13.
Although great advancements have been witnessed in treatment results for hematopoietic tumors in recent years, development of secondary malignant tumors induced by anti-cancer drugs still remains a serious issue. We experienced a case of secondary myelodysplastic syndrome (MDS), possibly induced by cyclophosphamide (CY), which was spontaneously resolved by discontinuance of CY. A 24-year-old woman was diagnosed with follicular lymphoma in January 1998: she had developed bulky intra-abdominal lymphadenopathy, with repeated relapse and remission by several chemotherapy treatments. Remission was induced by rituximab, administered at the time of relapse in 2001, followed by administration of 50 mg/day of CY since December 2001 for the prevention of relapse. Anemia and thrombocytopenia developed around January 2003. Bone marrow aspiration revealed abnormality in two lineages and a complicated chromosomal anomaly, and the patient was diagnosed with MDS. Discontinuance of CY and administration of an anabolic steroid improved anemia and thrombocytopenia within 2 years. Bone marrow aspiration in 2006 showed improvement in morphological abnormality and disappearance of chromosomal abnormality.
尽管近年来在治疗血液肿瘤方面取得了重大进展，但抗癌药物引起的继发性恶性肿瘤的发展仍然是一个严重的问题。我们遇到了一例可能由环磷酰胺（CY）引起的继发性骨髓增生异常综合征（MDS），停用 CY 后自行缓解。一名 24 岁女性于 1998 年 1 月被诊断为滤泡性淋巴瘤：她患有巨大的腹腔内淋巴结病，通过几次化疗治疗反复缓解和复发。2001 年复发时使用利妥昔单抗诱导缓解，随后自 2001 年 12 月起每天给予 50mg CY 预防复发。大约在 2003 年 1 月左右出现贫血和血小板减少症。骨髓抽吸显示两个谱系异常和复杂的染色体异常，诊断为 MDS。停用 CY 和给予合成代谢类固醇在 2 年内改善了贫血和血小板减少症。2006 年的骨髓抽吸显示形态异常改善和染色体异常消失。
