Gonzalez F, Trujillo J M, Alexanian R
Ann Intern Med. 1977 Apr;86(4):440-3. doi: 10.7326/0003-4819-86-4-440.
Of 476 patients with multiple myeloma treated during a 9-year period, 11 developed acute myelogenous leukemia or sideroblastic anemia. In all, the myeloma was in remission from chemotherapy with melphalan-prednisone combinations that had been continued for a median duration of 3 years. The incidence of acute leukemia or sideroblastic anemia was about 100 times higher than found in normal individuals of the same age. In all patients studied, major cytogenetic abnormalities were present, with hypodiploidy and evidence of chromosomal damage being noted most frequently. The frequency and nature of the chromosome changes were attributed to effects resulting from the prolonged drug therapy. These findings supported the long-term follow-up of selected patients with myeloma without any chemotherapy when marked degrees of remission followed the initial treatment courses.
在9年期间接受治疗的476例多发性骨髓瘤患者中，有11例发生了急性髓系白血病或铁粒幼细胞贫血。总体而言，骨髓瘤通过美法仑-泼尼松联合化疗获得缓解，该化疗持续的中位时间为3年。急性白血病或铁粒幼细胞贫血的发生率比同龄正常个体高约100倍。在所有研究患者中，均存在主要的细胞遗传学异常，其中亚二倍体和染色体损伤证据最为常见。染色体变化的频率和性质归因于长期药物治疗的影响。这些发现支持了对部分骨髓瘤患者进行长期随访，这些患者在初始治疗疗程后达到显著缓解且未接受任何化疗。
