THERAPY-RELATED ACUTE MYELOID-LEUKEMIA AND MYELODYSPLASTIC SYNDROME - A CLINICAL AND MORPHOLOGIC STUDY OF 65 CASES
THERAPY-RELATED ACUTE MYELOID-LEUKEMIA AND MYELODYSPLASTIC SYNDROME - A CLINICAL AND MORPHOLOGIC STUDY OF 65 CASES
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DOI：
10.1182/blood.v65.6.1364.bloodjournal6561364
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发表时间：
1985-01-01
期刊：
影响因子：
20.3
通讯作者：
BRUNNING, RD
中科院分区：
文献类型：
--
作者：
MICHELS, SD;MCKENNA, RW;BRUNNING, RD
本研究包括65例化疗和/或放射治疗后发生骨髓增生异常综合征(MDS)(39例)或急性髓系白血病(AML)(26例)的患者(PTS[患者])，从开始治疗到骨髓异常的时间为11-192mo。(中位数，58)。33名患者以前接受过淋巴增生性疾病的治疗，29名患者是癌症患者，3名患者是非肿瘤性疾病患者。在MDS期，大约30%的病例在1-12个月内发展为AML。(中位数，3.5)。49%的AML病例不容易根据法美英(FAB)标准进行分类；分类的主要困难与涉及多个细胞系有关。在可分类的病例中，除M1型外，其余FAB型均有表达，M2型是最常见的型。24例G显带患者中，22例(92%)骨髓标本中发现克隆性染色体异常，其中11例有5号和/或7号染色体异常。所有患者的中位生存期为4个月，抗白血病治疗组与未治疗组比较差异无统计学意义。中位生存期为3个月。出现急性髓系白血病的患者为6个月，MDS后的急性髓细胞白血病患者为4个月。对于MDS未演变为AML的患者。这项研究的结果表明，与治疗相关的泛髓增多症有3个阶段：全血细胞减少伴相关的骨髓增生异常改变、明显的MDS和明显的急性髓系白血病。许多患者会出现在显性AML阶段，与初诊AML不同的是，三联体受累发生率高，分类困难，细胞遗传学异常频繁，抗白血病治疗反应差。骨髓增生期，无论是否进展为急性白血病，都是一种高度致命的疾病，其中位存活率与AML患者相当。
This study consists of 65 patients (pts [patients]) who developed a myelodysplastic syndrome (MDS) (39 pts) or acute myeloid leukemia (AML) (26 pts) following chemotherapy and/or radiotherapy; the interval from the onset of therapy to bone marrow abnormality ranged from 11-192 mo. (median, 58). Thirty-three patients were previously treated for lymphoproliferative diseases, 29 for carcinoma, and 3 for a nonneoplastic disorder. Approximately 30% of the cases presenting in the MDS phase evolved to AML in 1-12 mo. (median, 3.5). The AML in 49% of the cases was not readily classified according to French-American-British (FAB) criteria; the primary difficulty in classification related to the involvement of multiple cell lines. Among the cases that could be classified, all FAB types were represented except for M1; M2 was the most frequent type. Clonal chromosome abnormalities were found in marrow specimens from 22 of 24 (92%) patients studied with G banding; 11 had abnormalities of chromosomes 5 and/or 7. The median survival for all patients was 4 mo., with no significant difference between those treated and not treated with antileukemic therapy. The median survival was 3 mo. for the patients presenting with AML, 6 mo., for the patients with AML following an MDS, and 4 mo. for the patients with an MDS that did not evolve to AML. The findings in this study suggest that there are 3 stages of therapy-related panmyelosis: pancytopenia with associated myelodysplastic changes, a frank MDS, and overt AML. Many patients will present in the stage of overt AML that differs from de novo AML primarily by the high incidence of trilineage involvement, difficulty in classification, frequent cytogenetic abnormalities and poor response to antileukemic therapy. The myelodysplastic phase, with or without evolution to acute leukemia, is a highly lethal disease with a median survival comparable to that of the patients who present with AML.