Department for Haematology, Oncology and Clinical Immunology, University of Duesseldorf Medical Faculty, Duesseldorf, Germany.
Haematologica. 2012 Feb;97(2):206-12. doi: 10.3324/haematol.2011.049114. Epub 2011 Oct 11.
Few data are available on therapy-related myelodysplastic syndromes and acute myeloid leukemia developing after radioiodine treatment.
We retrospectively analyzed 39 patients with myeloid neoplasms following radioiodine treatment, whose data were reported to the Duesseldorf Myelodysplastic Syndromes Register (8 of 3814 patients) and five other German Myelodysplastic Syndromes centers (n=31) between 1982 and 2011. These data were compared with those from 165 patients from our Myelodysplastic Syndromes Register with therapy-related myeloid neoplasms following chemotherapy (n=90), radiation (n=30), or radiochemotherapy (n=45).
With a median latency of 79 months, 18 patients developed therapy-related acute myeloid leukemia and 21 presented with therapy-related myelodysplastic syndromes (8 refractory anemia with excess blasts I/II, 6 refractory anemia with multilineage dysplasia, 3 myelodysplastic syndromes with del(5q), 1 refractory anemia, 1 refractory anemia with ring sideroblasts, 1 chronic myelomonocytic leukemia II, 1 myelodysplastic/myeloproliferative neoplasm unclassifiable). Risk assessment according to the International Prognostic Scoring System was low-risk in 23%, intermediate-1 in 29%, intermediate-2 in 35%, and high-risk in 13%. Karyotype was abnormal in 68%, with chromosomes 7 (30%), 5 (26%), 8 (26%) and 3 (17%) being most frequently affected. No differences in the distribution of gender, World Health Organization subtype, acute myeloid leukemia progression, International Prognostic Scoring System score, and cytogenetic risk were observed between patients with therapy-related myeloid neoplasms following radioiodine or other treatment modalities. Of 17 patients who received induction chemotherapy, 71% were refractory to this treatment or died from treatment-related toxicity. The median overall survival in the entire group was 21.7 months (95%-CI 10.5-33 months) and did not differ significantly in comparison to the survival of patients with therapy-related myeloid neoplasms following other cytotoxic treatments. Patients with therapy-related acute myeloid leukemia had significantly inferior overall survival (12.4 versus 28.7 months, P=0.002).
Patients developing a therapy-related myeloid neoplasm after radioiodine treatment usually present with biological characteristics similar to those seen in patients with therapy-related myeloid neoplasms following other cytotoxic treatment modalities, associated with a low response rate to induction chemotherapy and poor prognosis.
关于放射性碘治疗后发生的治疗相关性骨髓增生异常综合征和急性髓系白血病，目前仅有少量数据。
我们回顾性分析了 1982 年至 2011 年间，39 例因放射性碘治疗后发生髓系肿瘤而向杜塞尔多夫骨髓增生异常综合征登记处（3814 例患者中的 8 例）和其他 5 个德国骨髓增生异常综合征中心报告的患者（n=31）的数据。这些数据与我们的骨髓增生异常综合征登记处中因化疗（n=90）、放疗（n=30）或放化疗（n=45）而发生治疗相关性髓系肿瘤的 165 例患者的数据进行了比较。
中位潜伏期为 79 个月，18 例患者发生治疗相关性急性髓系白血病，21 例患者发生治疗相关性骨髓增生异常综合征（8 例难治性贫血伴原始细胞增多 I/II 型、6 例难治性贫血伴多系发育异常、3 例伴有 del(5q)的骨髓增生异常综合征、1 例难治性贫血、1 例难治性贫血伴环形铁幼粒细胞、1 例慢性粒单核细胞白血病 II 型、1 例骨髓增生异常/骨髓增殖性肿瘤不能分类）。根据国际预后评分系统评估，低危为 23%，中危-1 为 29%，中危-2 为 35%，高危为 13%。核型异常占 68%，最常见的异常染色体为 7（30%）、5（26%）、8（26%）和 3（17%）。放射性碘或其他治疗方法后发生治疗相关性髓系肿瘤的患者，在性别、世界卫生组织亚型、急性髓系白血病进展、国际预后评分系统评分和细胞遗传学风险方面，其分布无差异。17 例接受诱导化疗的患者中，71%对该治疗有耐药性或因治疗相关毒性而死亡。整个组的中位总生存期为 21.7 个月（95%CI 10.5-33 个月），与接受其他细胞毒性治疗的治疗相关性髓系肿瘤患者的生存情况无显著差异。发生治疗相关性急性髓系白血病的患者总生存期明显较差（12.4 个月与 28.7 个月，P=0.002）。
放射性碘治疗后发生治疗相关性髓系肿瘤的患者，其生物学特征通常与接受其他细胞毒性治疗的治疗相关性髓系肿瘤患者相似，对诱导化疗的反应率低，预后差。
