title: [A case of therapy-related leukemia/myelodysplastic syndrome following treatment of refractory testicular germ cell tumor].
abstract: We report a patient with a refractory testicular non-seminomatous germ cell tumor (NSGCT) who developed therapy-related leukemia (TRL) after undergoing salvage chemotherapy and multiple operations for repeat recurrences. Fifty months after the initial therapy, pancytopenia and myeloblasts were observed in the patient's peripheral blood while the patient was undergoing salvage chemotherapy for a fifth recurrence. A bone marrow examination showed evidence of myelodysplastic syndrome (MDS) and refractory anemia with excess of blasts in transformation (RAEB in T) under French-America-British (FAB) classification. Cytogenetic 5q-/7q- abnormalities were also observed. The patient had received a total dose of 189g/m2 of Ifosfamide, 8,250mg/m2 of Etoposide and 1,450 mg/m2 of Cisplatin; therefore, he was diagnosed as having TRL/MDS. The patient has received induction chemotherapy for TRL with Cytarabine, Daunorubicin and Fludarabine while a bone marrow transplantation has been scheduled. Recently, TRL associated with chemotherapy are being reported with increasing frequency in the literature. Since early detection and treatment are necessary for the management of TRL, peripheral blood examinations should be performed after a diagnosis of refractory germ cell tumor has been made. If pancytopenia is detected, bone marrow and cytogenetic examinations should be immediately performed to rule out TRL.
authors.affiliation: Department of Urology, Kanagawa Cancer Center.
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Takizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Fujinami
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osada
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Tanaka
authors.forename: Ichiro
authors.initials: I
authors.lastname: Maruta
mesh_terms: D000328:Adult; D000754:Anemia, Refractory, with Excess of Blasts / Q000473:pathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D015470:Leukemia, Myeloid, Acute / Q000209:etiology*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000209:etiology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000209:etiology*; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide