Acute myeloid leukemia and myelodysplasia following intensive chemotherapy for breast cancer.
Two major classes of therapy-related acute myeloid leukemias (t-AML) and myelodysplastic syndromes (t-MDS) have been described following the use of conventional doses of alkylating agents and epipodophyllotoxins. They are characterized by distinct clinical presentations and chromosomal abnormalities. We report 2 cases of t-AML and 1 case of t-MDS in 3 out of 36 women who underwent high-dose chemotherapy and attempted ABMT for breast cancer. Two patients developed t-AML 4 and 8 months following the initiation of high-dose chemotherapy with or without ABMT. The third patient developed t-MDS 23 months following dose-intensive chemotherapy and ABMT. Cytogenetic studies of the marrow metaphase chromosomes from the two patients who developed t-AML, including FISH analysis in 1 patient, showed a t(9;11)(p22ng,q23) abnormal chromosome 6 (ring chromosome). Neither patient had a preleukemic phase. Cytogenetic studies from the third patient who developed t-MDS showed abnormalities of chromosome 5 (-5) and a derivative of chromosome 17. The use of multiple chemotherapeutic agents in all 3 patients makes it difficult to attribute the development of these cases of t-MDS/t-AML to a single chemotherapeutic agent. The possible role of dose-intensive chemotherapy in the development of these secondary malignancies is discussed.
Roman-Unfer
S
S
Department of Medicine, Lutheran General Hospital, Park Ridge, Illinois, USA.
Bitran
J D
JD
Hanauer
S
S
Johnson
L
L
Rita
D
D
Booth
C
C
Chen
K
K
D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D002277:Carcinoma / Q000188:drug therapy* / Q000601:surgery; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007621:Karyotyping; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000209:etiology* / Q000235:genetics; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000209:etiology*