Therapy-related leukemia/myelodysplastic syndrome in multiple myeloma

摘要

Although recent advances in combination chemotherapy, high-dose radiotherapy, and combination of chemotherapy and radiotherapy have prolonged the survival time of cancer patients, developments of therapy-related malignancy have increased. We experienced 9 cases of therapy-related leukemia/myelodysplastic syndrome (TRL/TMDS) during the treatment of multiple myeloma (MM). Of 177 MM cases treated with combination chemotherapy for induction or maintenance therapy in our department between 1988 and 2008, 9 cases were diagnosed of TRL/TMDS. There were 6 males and 3 females and the median age at the diagnosis of TRL/TMDS was 69 years (54-78yrs). All 4 cases of TRL were myelogeneous leukemia. In 5 cases of TMDS, there were 2 refractory anemia, 1 refractory anemia with excess blasts(RAEB) and 2 chronic myelomonocytic leukemia(CMMoL). In 6 cases, the cumulative dose of melphalan exceeded 800 mg. The remission induction chemotherapy was performed in 3 cases and complete remission was achieved in 1 case and 2 were partial remission. In cases of TMDS, transfusion alone was performed in 2 cases, and controlling the white blood cell count alone in 3cases. Regarding the outcome, the median survival time was 6 months (follow-up period: 1-40 months). One patient have survived for more than 40 months, while 8 cases died caused of TRL or TMDS. The prevention of TRL/TMDS has become an important problem and careful long-term follow-up with periodic blood test is necessary after chemotherapy.