J Korean Med Sci.  2002 Aug;17(4):555-559. 10.3346/jkms.2002.17.4.555.

A Case of Treatment-Related Myelodysplastic syndrome and Acute Myelogenous Leukemia Following High-Dose Chemotherapy with Autologous Stem Cell Transplantation for Non-Hodgkin's Lymphoma

• Jang GD
• Kim SW
• Suh CW
• Kim EK
• Bahng HS
• Jeong YH
• Park IG
• Kim WK
• Kim SH
• Suh EJ
• Park CJ
• Ji HS
• Lee JS

• KMID: 1109769
• DOI: http://doi.org/10.3346/jkms.2002.17.4.555

Abstract

Treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (t-AML) are now well established as complications of cytotoxic chemotherapy. We experienced a 28-yr-old female patient who developed t-MDS/t-AML with characteristic chromosomal abnormalities including 11q23 chromosomal rearrangement following high-dose chemotherapy with autologous stem cell transplantation (ASCT) for non-Hodgkin's lymphoma. The patient was admitted with bulky abdominal masses of B cell lineage non-Hodgkin's lymphoma. After 2 cycles of systemic chemotherapy of the Vanderbilt regimen, the patient underwent ASCT with high dose chemotherapy of the BEAC regimen. She also received radiation of 48 Gy for the residual periportal lymphadenopathy. The initial cytogenetic analysis of the infused mononuclear cells revealed a normal karyotype. Twenty two months after the ASCT, pancytopenia was noted and her bone marrow aspirate showed dysplastic hemopoiesis with myeloblasts up to 12% of nonerythroid nucleated cells. The patient was diagnosed as t-MDS (refractory anemia with an excess of blasts). Cytogenetic analysis showed complex chromosomal abnormalities including 11q23 rearrangement, which is frequently found in topoisomerase II inhibitor-related hematologic malignancies. Four months later, it was noted that the t-MDS had evolved into an overt t-AML. Cytogenetic analysis showed an evolving pattern with more complex abnormalities. The patient was treated with combination che-motherapy, but her leukemic cells were resistant to the therapy.

Keyword

Myelodysplastic Syndromes; Leukemia; Myelocytic; Acute; Transplantation; Autologous; Gene Rearrangement

MeSH Terms

Adult
Antineoplastic Agents, Phytogenic/adverse effects
Antineoplastic Combined Chemotherapy Protocols/*adverse effects
B-Lymphocytes/cytology
Bone Marrow Cells/pathology
Carmustine/*adverse effects
Chromosome Aberrations
Chromosomes, Human, Pair 11
Combined Modality Therapy/adverse effects
Cyclophosphamide/*adverse effects
Cytarabine/*adverse effects
Etoposide/*adverse effects
Female
Gene Rearrangement
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Leukemia, Myeloid, Acute/*etiology/genetics
Lymphoma, Non-Hodgkin/*therapy
Myelodysplastic Syndromes/*etiology/genetics
Neoplasms, Second Primary/*etiology
Pelvis
Pregnancy
Pregnancy Complications, Neoplastic/*therapy
Transplantation, Autologous