Clinical-cytogenetic associations in 306 patients with therapy-related myelodysplasia and myeloid leukemia: the University of Chicago series
Clinical-cytogenetic associations in 306 patients with therapy-related myelodysplasia and myeloid leukemia: the University of Chicago series
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DOI：
10.1182/blood-2002-11-3343
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发表时间：
2003-07-01
期刊：
影响因子：
20.3
通讯作者：
Larson, RA
中科院分区：
文献类型：
--
作者：
Smith, SM;Le Beau, MM;Larson, RA
治疗相关性骨髓增生异常和髓性白血病（t-MDS/t-AML）是暴露于化疗（CT）或放疗（RT）后发生的一种独特的临床综合征。我们报告的结果，连续306例患者提到我们的机构与形态审查和细胞遗传学分析。自1972年以来，分析了141名男性和165名女性，初次诊断时的中位年龄为51岁（范围，3-83岁），二次诊断时的中位年龄为58岁（范围，6-86岁）。患者接受了各种细胞毒性药物，包括烷化剂（240例患者，78%）和拓扑异构酶2抑制剂（115例患者，39%）。121例（40%）仅接受了CT，43例（14%）仅接受了RT，139例（45%）接受了两种方式。在诊断为t-MDS/t-AML时，282例（92%）存在涉及5号染色体（n = 63）、7号染色体（n = 85）、5号和7号染色体（n = 66）的克隆异常、复发性平衡重排（n = 31）、其他克隆异常（n = 39）或正常核型（n = 24）。5，7号染色体或两者同时缺失占异常核型的76%。17例患者在自体干细胞移植后获得t-MDS/t-AML，但未观察到独特的细胞遗传学异常模式。观察到平衡重排患者的潜伏期较短（中位数，28 vs 67个月; P <0.0001）。急性白血病患者比骨髓增生异常患者更容易发生平衡重排（28%比4%; P <0.0001）。诊断为t-MDS/t-AML后的中位生存时间为8个月; 5年生存率低于10%。这些数据证实并扩展了先前t-MDS/tAML中临床、形态学和细胞遗传学结果之间的相关性。(C)2003年，美国血液学会。
Therapy-related myelodysplasia and myeloid leukemia (t-MDS/t-AML) is a distinctive clinical syndrome occurring after exposure to chemotherapy (CT) or radiotherapy (RT). We report findings on 306 consecutive patients referred to our institution with morphologic review and cytogenetic analyses. Since 1972, 141 males and 165 females with a median age of 51 years (range, 3-83 years) at primary diagnosis and 58 years (range, 6-86 years) at secondary diagnosis were analyzed. Patients had been administered various cytotoxic agents, including alkylating agents (240 patients, 78%) and topoisomerase 2 inhibitors (115 patients, 39%). One hundred twenty-one (40%) had undergone CT alone, 43 (14%) had undergone RT alone, and 139 (45%) had undergone both modalities. At diagnosis of t-MDS/t-AML, 282 (92%) had clonal abnormalities involving chromosome 5 (n = 63), chromosome 7 (n = 85), chromosomes 5 and 7 (n = 66), recurring balanced rearrangements (n = 31), other clonal abnormalities (n = 39), or normal karyotype (n = 24). Abnormalities of chromosome 5, 7, or both accounted for 76% of all cases with an abnormal karyotype. Seventeen patients acquired t-MDS/t-AML after autologous stem cell transplantation, but no unique pattern of cytogenetic abnormalities was observed. Shorter latency was observed for patients with balanced rearrangements (median, 28 vs 67 months; P < .0001). Patients with acute leukemia were more likely to have balanced rearrangement than those with myelodysplasia (28% vs; 4%; P < .0001). Median survival time after diagnosis of t-MDS/t-AML was 8 months; survival at 5 years was less than 10%. These data confirm and extend previous associations between clinical, morphologic, and cytogenetic findings in t-MDS/tAML. (C) 2003 by The American Society of Hematology.