Myelodysplastic syndrome and acute myelogenous leukemia as a late clonal complication in children with acquired aplastic anemia.
The improved outcome of acquired aplastic anemia (AA) has revealed later complications, such as myelodysplastic syndrome (MDS) and acute myelogenous leukemia (AML). We retrospectively analyzed 167 children with severe acquired AA. Eleven of 50 children treated with cyclosporin (CSA) and recombinant human granulocyte colony-stimulating factor (rhG-CSF) developed MDS/AML; 8 of these were within 36 months of the diagnosis of AA, much earlier than previous reports. Six of the 11 children received rhG-CSF exceeding 10 microg/kg/d, and 9 received rhG-CSF therapy for over 1 year. Ten children showed monosomy 7 at diagnosis of MDS. All of the 11 children were administered both CSA and rhG-CSF. There was no development of MDS/AML among 41 children treated with either CSA or rhG-CSF or among 48 children who underwent bone marrow transplantation. A well-controlled clinical trial is warranted to determine whether therapeutic modalities affect the development of MDS/AML in children with severe acquired AA.
Ohara
A
A
Aplastic Anemia Committee of the Japanese Society of Pediatric Hematology.
Kojima
S
S
Hamajima
N
N
Tsuchida
M
M
Imashuku
S
S
Ohta
S
S
Sasaki
H
H
Okamura
J
J
Sugita
K
K
Kigasawa
H
H
Kiriyama
Y
Y
Akatsuka
J
J
Tsukimoto
I
I
D000208:Acute Disease; D000293:Adolescent; D000741:Anemia, Aplastic / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D002897:Chromosomes, Human, Pair 7; D002999:Clone Cells / Q000473:pathology; D003131:Combined Modality Therapy / Q000009:adverse effects; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D004357:Drug Synergism; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006412:Hematopoietic Stem Cells / Q000187:drug effects / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D015994:Incidence; D007223:Infant; D007951:Leukemia, Myeloid / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015993:Life Tables; D008297:Male; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D016572:Cyclosporine; D000069585:Filgrastim