A case of treatment-related myelodysplastic syndrome and acute myelogenous leukemia following high-dose chemotherapy with autologous stem cell transplantation for non-Hodgkin's lymphoma.
Treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (t-AML) are now well established as complications of cytotoxic chemotherapy. We experienced a 28-yr-old female patient who developed t-MDS/t-AML with characteristic chromosomal abnormalities including 11q23 chromosomal rearrangement following high-dose chemotherapy with autologous stem cell transplantation (ASCT) for non-Hodgkin's lymphoma. The patient was admitted with bulky abdominal masses of B cell lineage non-Hodgkin's lymphoma. After 2 cycles of systemic chemotherapy of the Vanderbilt regimen, the patient underwent ASCT with high dose chemotherapy of the BEAC regimen. She also received radiation of 48 Gy for the residual periportal lymphadenopathy. The initial cytogenetic analysis of the infused mononuclear cells revealed a normal karyotype. Twenty two months after the ASCT, pancytopenia was noted and her bone marrow aspirate showed dysplastic hemopoiesis with myeloblasts up to 12% of nonerythroid nucleated cells. The patient was diagnosed as t-MDS (refractory anemia with an excess of blasts). Cytogenetic analysis showed complex chromosomal abnormalities including 11q23 rearrangement, which is frequently found in topoisomerase II inhibitor-related hematologic malignancies. Four months later, it was noted that the t-MDS had evolved into an overt t-AML. Cytogenetic analysis showed an evolving pattern with more complex abnormalities. The patient was treated with combination chemotherapy, but her leukemic cells were resistant to the therapy.
Jang
Geun Doo
GD
Department of Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
Kim
Sang-We
SW
Suh
Cheol Won
CW
Kim
Eun-Kyoung
EK
Bahng
Hye Seung
HS
Jeong
Young Hoon
YH
Park
Il Gwon
IG
Kim
Woo-Kun
WK
Kim
Sang-Hee
SH
Suh
Eul-Ju
EJ
Park
Chan-Jeoung
CJ
Ji
Hyun-Sook
HS
Lee
Jung-Shin
JS
D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001402:B-Lymphocytes / Q000166:cytology; D001854:Bone Marrow Cells / Q000473:pathology; D002330:Carmustine / Q000009:adverse effects*; D002869:Chromosome Aberrations; D002880:Chromosomes, Human, Pair 11; D003131:Combined Modality Therapy / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects*; D003561:Cytarabine / Q000009:adverse effects*; D005047:Etoposide / Q000009:adverse effects*; D005260:Female; D015321:Gene Rearrangement; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology* / Q000235:genetics; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000209:etiology* / Q000235:genetics; D016609:Neoplasms, Second Primary / Q000209:etiology*; D010388:Pelvis; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000628:therapy*; D014182:Transplantation, Autologous
D000972:Antineoplastic Agents, Phytogenic; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine