title: 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.
abstract: 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.
authors.affiliation: Department of Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Geun Doo
authors.initials: GD
authors.lastname: Jang
authors.forename: Sang-We
authors.initials: SW
authors.lastname: Kim
authors.forename: Cheol Won
authors.initials: CW
authors.lastname: Suh
authors.forename: Eun-Kyoung
authors.initials: EK
authors.lastname: Kim
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Bahng
authors.forename: Young Hoon
authors.initials: YH
authors.lastname: Jeong
authors.forename: Il Gwon
authors.initials: IG
authors.lastname: Park
authors.forename: Woo-Kun
authors.initials: WK
authors.lastname: Kim
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Kim
authors.forename: Eul-Ju
authors.initials: EJ
authors.lastname: Suh
authors.forename: Chan-Jeoung
authors.initials: CJ
authors.lastname: Park
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Ji
authors.forename: Jung-Shin
authors.initials: JS
authors.lastname: Lee
mesh_terms: 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
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine