Vol.55 No.3 May 2007

Six cases of therapy-related leukemia or myelodysplastic syndrome after treatment for solid cancer

Kazuhiko Natori, Haruka Izumi, Susumu Ishihara, Daisuke Nagase, Yoshinori Fujimoto, Motohiro Katoh, Masanori Umeda and Yasunobu Kuraishi

Division of Hematology and Oncology, Department of Internal Medicine, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan

Abstract

The development of therapy-related leukemia (TRL) and myelodysplastic syndrome (T-MDS) are the most serious complications of intensive cancer chemotherapy and radiotherapy. We report 6 cases -3 each- of TRL and T-MD after treatment for solid cancers. The primary solid cancers involved were 2 cases each of nonsmall-cell lung cancer and renal cell cancer and 1 case each of esophageal cancer, small-cell lung cancer, gastric cancer, and prostate cancer, including 2 cases of double cancer (small-cell lung cancer + prostate cancer and esophageal cancer + renal cell cancer). Post operative chemotherapy was conducted to treat solid cancers in 3 cases, combined therapy consisting of chemotherapy and radiotherapy in 2 cases, and surgical therapy alone in 1 case. The median interval from the primary solid cancer to TRL or T-MDS was 30 months (23-108). In 4 of the 6 cases, the abnormal karyotypes were observed in chromosomal analysis at bone marrow. Although 2 of 3 TRL cases were treated by combination chemotherapy, neither achieved complete remission (CR). In another case of TRL classified as M3 type based on the French-American-British classification, CR was achieved following treatment by all-trans retinoic acid. No cases of T-MDS underwent chemotherapy, but were treated with palliative care alone. Of the 6 cases reported here, 2 with T-MDS are alive and 4 have died. One died due to primary solid cancer (small-cell lung cancer), and the other 3 due to TRL or T-MDS.
An improved understanding of clinical and biological features of TRL and T-MDS is essential for successful preventing these disorders.

Key word

solid cancer, therapy-related leukemia, myelodysplastic syndrome

Received

January 9, 2007

Accepted

March 8, 2007

Jpn. J. Chemother. 55 (3): 225-229, 2007