De Gramont A, Louvet C, Krulik M, Smadja N, Donadio D, Laporte J P, Brissaud P, Smith M, Delâge J M, Drolet Y
Cancer. 1986 Aug 1;58(3):630-4. doi: 10.1002/1097-0142(19860801)58:3<630::aid-cncr2820580306>3.0.co;2-e.
Peripheral blood changes preceding therapy-related leukemia were studied in 105 patients who had received cytotoxic therapy, 53 for Hodgkin's disease and 52 for other cancers. Preleukemic anomalies were observed in 74.3% of the cases, appearing after a mean interval of 68.7 months after diagnosis of the initial cancer. This interval was only 57.5 months in patients aged 50 years or older and only 42.3 months in patients with Hodgkin's disease having received cytotoxic therapy for 6 months or less. The first changes most frequently observed were pancytopenia (24.8%) and isolated erythrocyte abnormalities such as anemia or macrocytosis (18.1%). Involvement of two cell lines, isolated thrombocytopenia or leukopenia, circulating immature cells, monocytosis, leukocytosis, or thrombocytosis were also observed. Therapy-related myelodysplastic syndrome was recognized in 19 patients and myelofibrosis in 3. Median duration of the preleukemic phase was 6 months; 9 months in cases of isolated erythrocyte involvement and 5 months in the other cases. Myelomonocytic or monoblastic leukemia appeared less frequently when the first sign involved erythrocytes only. Hematological surveillance thus appears necessary in all patients having received cytotoxic therapy. Bone marrow study with cytogenetic examination should be performed in cases of persistent peripheral blood abnormalities.
对105例接受细胞毒性治疗的患者进行了研究，以观察与治疗相关的白血病之前的外周血变化，其中53例患有霍奇金病，52例患有其他癌症。74.3%的病例观察到白血病前期异常，出现在初始癌症诊断后的平均68.7个月。50岁及以上患者的这一间隔仅为57.5个月，接受细胞毒性治疗6个月或更短时间的霍奇金病患者的这一间隔仅为42.3个月。最常观察到的最初变化是全血细胞减少（24.8%）和孤立的红细胞异常，如贫血或大红细胞症（18.1%）。还观察到两种细胞系受累、孤立性血小板减少或白细胞减少、循环未成熟细胞、单核细胞增多、白细胞增多或血小板增多。19例患者被诊断为治疗相关的骨髓增生异常综合征，3例为骨髓纤维化。白血病前期的中位持续时间为6个月；单纯红细胞受累的病例为9个月，其他病例为5个月。当最初体征仅涉及红细胞时，骨髓单核细胞性或单核母细胞性白血病出现的频率较低。因此，对所有接受细胞毒性治疗的患者进行血液学监测似乎是必要的。对于持续存在外周血异常的病例，应进行骨髓检查和细胞遗传学检查。
