Koo So-My, Kim Ki-Up, Kim Yang-Ki, Uh Soo-Taek
Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea.
World J Clin Cases. 2021 Aug 26;9(24):7205-7211. doi: 10.12998/wjcc.v9.i24.7205.
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are tolerable drugs used for patients with EGFR-mutant advanced non-small cell lung cancer (NSCLC). Serious adverse reactions are uncommon compared with cytotoxic drugs.
A 52-year-old man presented with general weakness and cytopenia. He had been taking erlotinib for 11 mo to treat NSCLC. The pathological diagnosis from the right upper lobe mass was adenocarcinoma with an EGFR mutation in exon 21 (L858R). He had previously received paclitaxel/carboplatin, gemcitabin/ vinorelbine chemotherapy, stereotactic radiosurgery for brain metastasis, and whole-brain radiotherapy as treatment for NSCLC. We diagnosed the patient with acute myeloid leukemia (AML). During the induction and consolidation chemotherapy for AML, the erlotinib was discontinued. When complete remission of the AML was achieved, since the lung masses were increased, pemetrexed/ cisplatin for the NSCLC was initiated. After two cycles of chemotherapy, the cytopenia was prolonged. AML relapse occurred with the same karyotype.
Therapy-related acute myeloid neoplasm (t-MN) is a rare but fatal late complication. Although a patient may be taking EGFR-TKIs, the possibility of t-MN should be considered. Further studies are needed to determine whether EGFR-TKI usage is a predisposing factor for t-MN.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）是用于表皮生长因子受体（EGFR）突变的晚期非小细胞肺癌（NSCLC）患者的耐受性良好的药物。与细胞毒性药物相比，严重不良反应并不常见。
一名52岁男性出现全身乏力和血细胞减少。他服用厄洛替尼治疗非小细胞肺癌已11个月。右上叶肿块的病理诊断为腺癌，外显子21（L858R）存在EGFR突变。他之前接受过紫杉醇/卡铂、吉西他滨/长春瑞滨化疗、脑转移立体定向放射外科治疗以及全脑放疗作为非小细胞肺癌的治疗。我们诊断该患者患有急性髓系白血病（AML）。在急性髓系白血病的诱导和巩固化疗期间，停用了厄洛替尼。当急性髓系白血病达到完全缓解时，由于肺部肿块增大，开始使用培美曲塞/顺铂治疗非小细胞肺癌。两个化疗周期后，血细胞减少持续存在。急性髓系白血病以相同核型复发。
治疗相关的急性髓系肿瘤（t-MN）是一种罕见但致命的晚期并发症。尽管患者可能正在服用EGFR-TKIs，但仍应考虑t-MN的可能性。需要进一步研究以确定EGFR-TKI的使用是否是t-MN的诱发因素。
