Division of Hematology, Niguarda Ca' Granda Hospital, Milano, Italy.
Mediterr J Hematol Infect Dis. 2011;3(1):e2011031. doi: 10.4084/MJHID.2011.031. Epub 2011 Jul 9.
Secondary myelodysplasia (MDS) and acute myeloid leukemia (AML) are frequent long term complications in Chronic Lymphocytic Leukemia (CLL) and Waldenström Macroglobulinemia (WM) patients. Although disease-related immune-suppression plays a crucial role in leukemogenesis there is great concern that therapy may further increase the risk of developing these devastating complications.Nucleoside analogs (NA) and alkylating agents are considered appropriate agents in the treatment of both CLL and WM patients. Prolonged immunosuppression related to NA therapy and the incorporation of these agents or their metabolites into DNA, with potentially mutagenic action, leads to speculation that their therapeutic use might be responsible for an increased incidence of second cancer especially when combined with other DNA damaging agents like alkylating agents.In this review the published studies considering the occurrence of secondary MDS and AML in CLL and WM patients are reported and the potential role of chemotherapeutic agents in leukemogenesis is discussed.
继发性骨髓增生异常综合征（MDS）和急性髓系白血病（AML）是慢性淋巴细胞白血病（CLL）和华氏巨球蛋白血症（WM）患者的常见长期并发症。虽然疾病相关的免疫抑制在白血病发生中起着至关重要的作用，但人们非常担心治疗可能会进一步增加发生这些毁灭性并发症的风险。核苷类似物（NA）和烷化剂被认为是 CLL 和 WM 患者治疗的合适药物。与 NA 治疗相关的长期免疫抑制以及这些药物或其代谢物掺入 DNA 中，具有潜在的诱变作用，这导致人们推测它们的治疗用途可能会导致第二癌症的发生率增加，尤其是当与其他 DNA 损伤剂如烷化剂联合使用时。在这篇综述中，报告了考虑 CLL 和 WM 患者继发性 MDS 和 AML 发生的已发表研究，并讨论了化疗药物在白血病发生中的潜在作用。
