Acute Myeloid Leukemia and Myelodysplastic Syndromes After Radiation Therapy Are Similar to De Novo Disease and Differ From Other Therapy-Related Myeloid Neoplasms
Acute Myeloid Leukemia and Myelodysplastic Syndromes After Radiation Therapy Are Similar to De Novo Disease and Differ From Other Therapy-Related Myeloid Neoplasms
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DOI：
10.1200/jco.2011.38.7340
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发表时间：
2012-07-01
影响因子：
45.3
通讯作者：
Hasserjian, Robert P.
中科院分区：
文献类型：
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作者：
Nardi, Valentina;Winkfield, Karen M.;Hasserjian, Robert P.
治疗相关性髓系肿瘤（t-MN）是一种独特的临床综合征，发生在接受化疗和/或外束放疗（XRT）治疗的患者中，与新发疾病相比，其预后较差。近年来，XRT技术不断发展，与显著减少骨髓暴露有关。后xrt - mn在当前时代的特征尚未研究。患者和方法我们分析了单纯XRT（47例）或细胞毒性化疗/联合治疗（C/CMT， 181例）后发生急性髓性白血病（AML）或骨髓增生异常综合征（MDS）的患者，并将其与新发MDS或AML患者（222例）进行比较。我们估计了骨髓暴露于辐射，并比较了XRT患者与C/CMT患者和新发MDS和AML患者的临床、病理和细胞遗传学特征和预后。结果与C/CMT组相比，单纯XRT后t-MN患者的总生存期（P = 0.006）更高，高危核型发生率（AML P = 0.01, MDS P < 0.001）更低。相比之下，XRT组和新生组在生存率和高危核型频率上没有显著差异。结论过去10年单纯接受XRT治疗后诊断出的AML和MDS与C/CMT后发生的t-MN不同，与新发AML/MDS具有相同的遗传特征和临床行为。我们的研究结果表明，xrt后MDS/AML可能不代表辐射毒性的直接后果，需要类似于新生疾病的治疗方法。
PurposeTherapy-related myeloid neoplasms (t-MN) represent a unique clinical syndrome occurring in patients treated with chemotherapy and/or external-beam radiation (XRT) and are characterized by poorer prognosis compared with de novo disease. XRT techniques have evolved in recent years and are associated with significantly reduced bone marrow exposure. The characteristics of post-XRT t-MN in the current era have not been studied.Patients and MethodsWe analyzed patients who developed acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) after XRT alone (47 patients) or cytotoxic chemotherapy/combined-modality therapy (C/CMT, 181 patients) and compared them with patients with de novo MDS or AML (222 patients). We estimated bone marrow exposure to radiation and compared the clinical, pathologic, and cytogenetic features and outcome of the XRT patients with the C/CMT patients and with patients with de novo MDS and AML.ResultsPatients with t-MN after XRT alone had superior overall survival (P = .006) and lower incidence of high-risk karyotypes (P = .01 for AML and < .001 for MDS) compared with patients in the C/CMT group. In contrast, there were no significant differences in survival or frequency of high-risk karyotypes between the XRT and de novo groups.ConclusionAML and MDS diagnosed in the past decade in patients after receiving XRT alone differ from t-MN occurring after C/CMT and share genetic features and clinical behavior with de novo AML/MDS. Our results suggest that post-XRT MDS/AML may not represent a direct consequence of radiation toxicity and warrant a therapeutic approach similar to de novo disease.