Grünwald H W, Rosner F
Arch Intern Med. 1979 Apr;139(4):461-6.
We have reviewed 61 reported cases of acute leukemia developing in patients who had previously received immunosuppressive agents for non-neoplastic disorders. In three patients the diagnosis of acute leukemia was made less than six months after the first exposure to immunosuppressive drugs and was, therefore, considered coincidental. Among the remaining 58 patients, most diagnoses were of myeloblastic or myelomonocytic leukemia. The underlying diagnoses in most of the 58 patients were rheumatoid arthritis or renal disease or renal transplant. Thirty patients had received alkylating agents exclusively, 10 had received antimetabolites only, while the remaining 18 patients had received multiple therapeutic modalities including antimetabolites, alkylating agents, and/or radiation. Most patients had also received large amounts of corticosteroids. Although we do not have the overall denominator of population at risk, the relatively high proportion of patients who had received alkylating agents before developing acute leukemia doses suggest a causal relationship, and one might, therefore, hesitate before using such drugs in non-life-threatening diseases.
我们回顾了61例报告病例，这些病例均为曾因非肿瘤性疾病接受免疫抑制剂治疗的患者发生急性白血病。其中3例患者在首次接触免疫抑制药物后不到6个月就被诊断为急性白血病，因此被认为是巧合。在其余58例患者中，大多数诊断为成髓细胞性或粒单核细胞性白血病。这58例患者中大多数的基础诊断为类风湿性关节炎、肾脏疾病或肾移植。30例患者仅接受了烷化剂治疗，10例仅接受了抗代谢物治疗，而其余18例患者接受了多种治疗方式，包括抗代谢物、烷化剂和/或放疗。大多数患者还接受了大量的皮质类固醇。尽管我们没有处于危险中的总体人群分母，但在发生急性白血病之前接受烷化剂治疗的患者比例相对较高，这表明存在因果关系，因此，在非危及生命的疾病中使用此类药物时可能会有所犹豫。
