Ellis M, Lishner M
Department of Medicine, Meir Hospital, Kfar Saba, Israel.
Leuk Lymphoma. 1993 Mar;9(4-5):337-42. doi: 10.3109/10428199309148531.
Second malignancies represent an important iatrogenic complication of the treatment of hematologic and other neoplasms. In this review we summarize the literature relating specifically to malignancies developing in the wake of treated non-Hodgkin's lymphoma (NHL). In these patients, the risk of myelodysplastic syndrome (MDS) and acute non lymphocytic leukemia (ANLL) is reported to be increased 10-105 fold over that of the general population. Factors in the development of MDS and ANLL include basic defects in cellular immunity in NHL patients as well as treatment with alkylating agents and low dose total body irradiation. Biologically these secondary MDS and ANLLs are characterized by specific cytogenetic abnormalities and results of treatment are poor. Currently bone marrow transplantation offers the only potential cure. There is no clear statistical evidence that solid tumors occur more frequently after NHL. However, bladder carcinoma, in cyclophosphamide treated patients, and lung cancer have been reported by some to occur with an increased incidence. Further investigation of the molecular events leading to the occurrence of second malignancies in NHL patients and the role played by oncogenes and tumor suppressor genes in this process is still needed.
第二原发恶性肿瘤是血液系统及其他肿瘤治疗后的一种重要医源性并发症。在本综述中，我们总结了专门关于经治疗的非霍奇金淋巴瘤（NHL）后发生恶性肿瘤的相关文献。据报道，这些患者发生骨髓增生异常综合征（MDS）和急性非淋巴细胞白血病（ANLL）的风险比普通人群增加了10至105倍。MDS和ANLL发生的因素包括NHL患者细胞免疫的基础缺陷以及烷化剂治疗和低剂量全身照射。从生物学角度来看，这些继发性MDS和ANLL具有特定的细胞遗传学异常特征，治疗效果较差。目前骨髓移植是唯一可能治愈的方法。没有明确的统计学证据表明NHL后实体瘤更频繁发生。然而，一些报道称，在接受环磷酰胺治疗的患者中膀胱癌以及肺癌的发病率有所增加。仍需要进一步研究导致NHL患者发生第二原发恶性肿瘤的分子事件以及癌基因和肿瘤抑制基因在此过程中所起的作用。
