title: A Case of Therapy-Related Acute Myeloid Leukemia Associated with Adjuvant Temozolomide Chemotherapy for Anaplastic Astrocytoma.
abstract: BACKGROUND
  Temozolomide (TMZ) is now standard adjuvant therapy in combination with radiotherapy for patients with newly diagnosed malignant glioma. Treatment-related myelodysplastic syndrome and acute treatment-related leukemia (t-AML) associated with TMZ chemotherapy for patients with glioma is quite a rare complication.
  
  
  METHODS
  A 43-year-old man with an anaplastic astrocytoma received radiation therapy synchronized with ranimustine and adjuvant TMZ chemotherapy for 15 cycles. Close follow-up magnetic resonance imaging of the head during TMZ chemotherapy showed no evidence of tumor progression. One year after the completion of TMZ chemotherapy, a bone-marrow aspiration was performed because the patient's white blood cell count decreased. He was diagnosed with t-AML based on the bone marrow examination, and then he was referred to the cancer center for the treatment of t-AML.
  
  
  CONCLUSIONS
  In this case study, we continued adjuvant TMZ therapy beyond the recommended 6 cycles. Currently, there is no consensus as to how long the adjuvant TMZ therapy should be continued for the treatment of residual tumor showing no apparent interval change. A new decision-making tool to assess the clinical benefits against the side effects for long-term adjuvant TMZ therapy is needed.
authors.affiliation: Department of Neurosurgery, National Hospital Organization Tochigi Medical Center, Tochigi, Japan. Electronic address: kensan03977@yahoo.co.jp.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Kosugi
authors.affiliation: Department of Neurosurgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Hematology, Japan Red Cross Ashikaga Hospital, Tochigi, Japan; Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Takahashi
authors.affiliation: Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yukina
authors.initials: Y
authors.lastname: Tokuda
authors.affiliation: Department of Neurosurgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tomita
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Adjuvant temozolomide chemotherapy; Alkylating agents; Glioma; Therapy-related myelodysplastic syndrome/acute myeloid leukemia