title: Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma with fludarabine, mitoxantrone, and dexamethasone (FND) plus rituximab and interferon alpha.
abstract: Treatment-related myelodysplasia (t-MDS) occurs less frequently with the nucleoside analogs than with DNA-damaging agents such as alkylators or topoisomerase II inhibitors. In a chemoimmunotherapy trial conducted between 1997 and 2003 in patients with stage IV indolent lymphoma, 202 patients were treated and 8 have developed MDS between 1 and 5 years after therapy, including 4 who received only fludarabine, mitoxantrone, and dexamethasone (FND) for 6 to 8 courses, with or without rituximab, followed by interferon alpha (IFN-alpha). Complex cytogenetic abnormalities were present in all patients. Abnormalities of chromosome 7 were present in 6 of the 8 patients, 3 of whom received only FND +/- rituximab and IFN-alpha. The abnormalities of chromosome 7 were monosomy 7 in 4 patients (1 of which had add 7p in the remaining chromosome); 1 del 7q; and 1 der 7. MDS with features classically associated with DNA-damaging agents can occur following therapy with FND, with or without rituximab, and IFN-alpha.
authors.affiliation: Department of Lymphoma/Myeloma, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 429, Houston, USA. pmclaugh@mdanderson.org
authors.forename: Peter
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Elihu
authors.initials: E
authors.lastname: Estey
authors.forename: Armand
authors.initials: A
authors.lastname: Glassman
authors.forename: Jorge
authors.initials: J
authors.lastname: Romaguera
authors.forename: Felipe
authors.initials: F
authors.lastname: Samaniego
authors.forename: Ana
authors.initials: A
authors.lastname: Ayala
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hayes
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Maddox
authors.forename: H Alejandro
authors.initials: HA
authors.lastname: Preti
authors.forename: Fredrick B
authors.initials: FB
authors.lastname: Hagemeister
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002869:Chromosome Aberrations; D002897:Chromosomes, Human, Pair 7; D003131:Combined Modality Therapy; D004249:DNA Damage; D003907:Dexamethasone / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D016898:Interferon-alpha / Q000008:administration & dosage*; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced* / Q000175:diagnosis*; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage*; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000139:chemically induced* / Q000175:diagnosis*; D012074:Remission Induction; D000069283:Rituximab; D013997:Time Factors; D014740:Vidarabine / Q000008:administration & dosage* / Q000031:analogs & derivatives*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D016898:Interferon-alpha; D000069283:Rituximab; D003907:Dexamethasone; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine
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