Nakamura H, Sato T, Watanabe T, Ikeda S, Sadamori N, Ichimaru M
Rinsho Ketsueki. 1989 Feb;30(2):216-21.
A case of therapy-related myelodysplastic syndromes (t-MDS) in 66-year-old male patient is reported. The patient was diagnosed as having multiple myeloma in July 1983. Cyclophosphamide was given since September 1984, and melphalan was added since June 1986. Radiation therapy was not performed. Mild, slowly aggravating pancytopenia developed in July 1987. By December 1987, the hemoglobin level dropped to 6.0 g/dl, leukocytes to 2,800/microliters, and platelets to 15,000/microliters. At that time, 27% of the bone marrow cells were blasts and 23.3% monocytoid cells. Based on these findings, a diagnosis of t-MDS was made. He was managed by supportive care only, but the monocytoid cells increased rapidly in number and he died of pulmonary bleeding in March 1988. Chromosomal banding studies of the bone marrow cells revealed dir ins [inv (17) (p13q21); 21] (q21; p13q22) in all the 11 metaphases examined, but chromosomes No. 5 and 7 were normal. However, Keldsen et al reported that chromosome 21q rearrangements were nonrandomly associated with t-MDS and t-acute nonlymphocytic leukemia.
报告了一例66岁男性患者的治疗相关骨髓增生异常综合征（t-MDS）。该患者于1983年7月被诊断为多发性骨髓瘤。自1984年9月起给予环磷酰胺治疗，自1986年6月起加用美法仑。未进行放射治疗。1987年7月出现轻度、逐渐加重的全血细胞减少。到1987年12月，血红蛋白水平降至6.0g/dl，白细胞降至2800/微升，血小板降至15000/微升。此时，27%的骨髓细胞为原始细胞，23.3%为单核样细胞。基于这些发现，做出了t-MDS的诊断。仅对其进行支持性治疗，但单核样细胞数量迅速增加，他于1988年3月死于肺出血。对骨髓细胞进行的染色体显带研究显示，在所有检测的11个中期相中均存在dir ins [inv(17)(p13q21); 21](q21; p13q22)，但5号和7号染色体正常。然而，凯尔森等人报告称，21号染色体q臂重排与t-MDS和t-急性非淋巴细胞白血病存在非随机关联。
