title: Myelodysplastic syndrome following therapy for brain tumor--two case reports.
abstract: A 3-month-old boy and a 29-year-old woman presented with myelodysplastic syndrome (MDS) following therapy for primary malignant brain tumor. Both received intensive alkylating agent doses for induction and maintenance chemotherapy combined with craniospinal or cranial radiation for medulloblastoma and anaplastic astrocytoma, respectively. They developed refractory anemia and pancytopenia. Approximately 9 years after the completion of induction chemoradiotherapy, chromosomal analysis of bone marrow cells resulted in the diagnosis of MDS. The boy died of leukemic evolution 15 months later, the woman died of hematopoietic failure 3 months later. The most common symptom of MDS is refractory anemia, either alone or as part of bi- or pancytopenia. Clonal proliferation with chromosomal analysis of bone marrow cells establishes the diagnosis of MDS. Patients with malignant brain tumors are at risk of the development of MDS as a late complication of chemotherapy based on high cumulative doses of alkylating agents.
authors.affiliation: Department of Neurosurgery, Hiroshima University Medical Hospital, Hiroshima. brain@hiroshima-u.ac.jp
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
authors.forename: Eiji
authors.initials: E
authors.lastname: Taniguchi
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Okamura
authors.forename: Yoko
authors.initials: Y
authors.lastname: Itoh
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Yamasaki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kajiwara
authors.forename: Haruo
authors.initials: H
authors.lastname: Ueda
authors.forename: Akira
authors.initials: A
authors.lastname: Sakai
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001254:Astrocytoma / Q000188:drug therapy* / Q000532:radiotherapy; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000532:radiotherapy; D009190:Myelodysplastic Syndromes / Q000139:chemically induced*
chemical_list: D018906:Antineoplastic Agents, Alkylating