Hematology/Oncology department, Appalachian Regional Healthcare system, 306 Hospital Drive, South Williamson, KY 41503.
Clin Med Insights Oncol. 2012;6:149-52. doi: 10.4137/CMO.S8810. Epub 2012 Mar 7.
We report a 41 year old male with sickle cell disease who developed a myelodysplastic syndrome and acute myeloid leukemia with complex karyotype involving chromosomes 5, 7 and 17 after 15 years of hydroxyurea treatment. He responded poorly to induction chemotherapy with cytarabine/idarubicin followed by high dose cytarabine and succumbed to neutropenic sepsis. Multiple systematic reviews, observational studies and clinical trials were conducted to identify the toxicity profile of hydroxurea. Only six cases of leukemia/myelodysplastic syndrome were identified in patients with sickle cell anemia treated with hydroxyurea. Subsequently, it was concluded that hydroxyurea is not leukemogenic. However, it was noted that most of the published studies had only up to 9 years of follow-up. Our patient was started on hydroxyurea in 1990, before the widespread use of the drug and took hydroxyurea for 15 years. His presentation may reflect an outcome otherwise not yet observed because of the short follow-up of prior studies. We believe that the leukemogenic risk of hydroxyurea should be discussed with the patients and their families. Studies evaluating the adverse effects of hydroxyurea should have longer follow-up before definitive conclusions are drawn.
我们报告了一例 41 岁男性镰状细胞病患者，在接受羟基脲治疗 15 年后，发生了涉及 5、7 和 17 号染色体的骨髓增生异常综合征和急性髓系白血病伴复杂核型。他对阿糖胞苷/伊达比星诱导化疗反应不佳，随后进行了高剂量阿糖胞苷化疗，但死于中性粒细胞减少性脓毒症。进行了多项系统评价、观察性研究和临床试验，以确定羟基脲的毒性特征。在接受羟基脲治疗的镰状细胞贫血患者中，仅发现了 6 例白血病/骨髓增生异常综合征病例。随后得出结论，羟基脲没有致白血病作用。然而，值得注意的是，大多数已发表的研究仅随访了 9 年。我们的患者于 1990 年开始使用羟基脲，当时该药物尚未广泛使用，且已使用羟基脲治疗了 15 年。他的表现可能反映了由于先前研究的随访时间较短而尚未观察到的结果。我们认为，应与患者及其家属讨论羟基脲的致白血病风险。在得出明确结论之前，评估羟基脲不良反应的研究应具有更长的随访时间。
