Clément F
Schweiz Med Wochenschr. 1979 Apr 14;109(15):544-51.
Among 246 patients (49 with Hodgkin's disease, 29 with multiple myeloma, 75 with other lympho- and immunoproliferative syndromes, 70 with carcinomas and 23 with non-malignant affections) treated by cytostatic or immunosuppressive chemotherapy, 6 developed malignant hemopathy (acute myeloblastic leukemia, erythroleukemia and erythremia) apparently induced during the last 7 1/2 years. In addition, 2 carcinomas have been noted. All have received melphalan or chlorambucil, alone or associated with other cytostatic drugs. 5 out of these 6 patients also underwent radiotherapy. The lenght of chemotherapy ranged between 7 and 110 months and the latency between 45 and 110 months. A "preleukemic" cytopenia phase was observed in 4 out of 6 cases. An exceptional 45-month survival was secured in case 1 (acute myeloblastic leukemia in a patient probably cured of Hodgkin's disease IIIB). Observation 2 is the 3rd case ever published of induced acute leukemia in disseminated lupus erythematosus. All these observations are compared with the latest findings in the literature. To the very extent that the utilization of cytostatic drugs produces improvement in the prognosis of very serious diseases, their leukemogenic potential becomes more dangerous and demands limitation of their use.
在接受细胞毒性或免疫抑制化疗的246例患者中(49例患有霍奇金病,29例患有多发性骨髓瘤,75例患有其他淋巴和免疫增殖综合征,70例患有癌症,23例患有非恶性疾病),有6例在过去7年半期间显然诱发了恶性血液病(急性粒细胞白血病、红白血病和红细胞增多症)。此外,还发现了2例癌症。所有患者均接受过美法仑或苯丁酸氮芥治疗,单独使用或与其他细胞毒性药物联合使用。这6例患者中有5例还接受了放射治疗。化疗疗程为7至110个月,潜伏期为45至110个月。6例中有4例观察到“白血病前期”血细胞减少阶段。病例1(一名可能已治愈霍奇金病IIIB期的患者患急性粒细胞白血病)获得了长达45个月的生存期,实属罕见。观察病例2是已发表的第3例播散性红斑狼疮诱发急性白血病的病例。所有这些观察结果均与文献中的最新发现进行了比较。鉴于细胞毒性药物的使用在改善非常严重疾病的预后方面有一定作用,其致白血病潜力变得更加危险,因此需要限制其使用。