title: Myelodysplastic syndrome with complex karyotypic abnormality in a patient with Waldenström's macroglobulinemia after sequential treatment with chlorambucil and fludarabine.
abstract: A therapy-related myelodysplastic syndrome (t-MDS) during the course of Waldenström's macroglobulinemia (WM) has been observed in rare patients. In most of them, the condition developed after treatment with alkylating agents. We experienced a 65-year-old male patient who was diagnosed as WM. He was treated with intermittent oral chlorambucil for 12 months and three cycles of fludarabine, and complete response was achieved after fludarabine treatment. During routine outpatient follow-up, severe anemia occurred. His bone marrow aspirate showed dysplastic hemopoiesis with ringed sideroblasts and siderocytes, which is consistent with MDS (refractory anemia with ringed sideroblasts). Cytogenetic analysis showed complex chromosomal abnormalities including 5q deletion, 12p deletion and monosomy 18. When decision is made to treat WM with chlorambucil and/or fludarabine, a potential risk for t-MDS or therapy-related acute myeloid leukemia should be considered and a close hematologic monitoring is needed.
authors.affiliation: Division of Oncology-Hematology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Chun
authors.forename: Kyeong Ok
authors.initials: KO
authors.lastname: Kim
authors.forename: Min Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Kyung Hee
authors.initials: KH
authors.lastname: Lee
authors.forename: Myung Soo
authors.initials: MS
authors.lastname: Hyun
authors.forename: Hee Soon
authors.initials: HS
authors.lastname: Cho
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D002699:Chlorambucil / Q000008:administration & dosage / Q000009:adverse effects; D002869:Chromosome Aberrations; D002872:Chromosome Deletion; D002881:Chromosomes, Human, Pair 12; D002887:Chromosomes, Human, Pair 18; D002895:Chromosomes, Human, Pair 5; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000139:chemically induced* / Q000235:genetics*; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002699:Chlorambucil; D014740:Vidarabine; C024352:fludarabine