Marc C Chamberlain1, Jeffrey Raizer. 1. Department of Neurology and Neurological Surgery, University of Washington, DC, USA. chambemc@u.washington.edu
Abstract
OBJECTIVE: A case series of gliomas treated with alkylator-based chemotherapy who subsequently developed myelodysplastic syndrome (tMDS) or acute myelocytic leukemia (AML). BACKGROUND: Alkylator-based chemotherapy is recognized to be leukemogenic; however, it is infrequently described as a delayed consequence of anti-glioma treatment. METHODS: Seven patients (4 men; 3 women) ages 34-69 years (median 44), with gliomas (3 Grade 2; 4 Grade 3) were treated with surgery, all but one with involved-field radiotherapy and all with alkylator-based chemotherapy (temozolomide; 6 patients, nitrosoureas; 5 patients, both agents; 5 patients). RESULTS: Exposure to alkylator-based chemotherapy ranged from 8 to 30 months (median 24). The diagnosis of tMDS was determined by bone marrow biopsy in 7 patients. Seven patients showed chromosomal abnormalities consistent with chemotherapy induced MDS. Three patients were diagnosed with AML as well (in two determined by bone marrow and one at autopsy). Interval from last chemotherapy exposure to diagnosis of tMDS/AML ranged from 3 to 31 months (median 24 months). Two patients were treated with bone marrow transplantation and 5 received supportive care only. Five patients have died, 2 as a consequence of recurrent brain tumor, 1 as a complication of transplantation, and 2 due to AML. CONCLUSIONS: Although rare, induction of tMDS/AML following extended use of alkylator-based chemotherapy may become more relevant with the evolving practice to treat gliomas for protracted periods. Future work to determine at risk patients would be important.
OBJECTIVE: A case series of gliomas treated with alkylator-based chemotherapy who subsequently developed myelodysplastic syndrome (tMDS) or acute myelocytic leukemia (AML). BACKGROUND: Alkylator-based chemotherapy is recognized to be leukemogenic; however, it is infrequently described as a delayed consequence of anti-glioma treatment. METHODS: Seven patients (4 men; 3 women) ages 34-69 years (median 44), with gliomas (3 Grade 2; 4 Grade 3) were treated with surgery, all but one with involved-field radiotherapy and all with alkylator-based chemotherapy (temozolomide; 6 patients, nitrosoureas; 5 patients, both agents; 5 patients). RESULTS: Exposure to alkylator-based chemotherapy ranged from 8 to 30 months (median 24). The diagnosis of tMDS was determined by bone marrow biopsy in 7 patients. Seven patients showed chromosomal abnormalities consistent with chemotherapy induced MDS. Three patients were diagnosed with AML as well (in two determined by bone marrow and one at autopsy). Interval from last chemotherapy exposure to diagnosis of tMDS/AML ranged from 3 to 31 months (median 24 months). Two patients were treated with bone marrow transplantation and 5 received supportive care only. Five patients have died, 2 as a consequence of recurrent brain tumor, 1 as a complication of transplantation, and 2 due to AML. CONCLUSIONS: Although rare, induction of tMDS/AML following extended use of alkylator-based chemotherapy may become more relevant with the evolving practice to treat gliomas for protracted periods. Future work to determine at risk patients would be important.
Authors: A C Kappelle; T J Postma; M J Taphoorn; G J Groeneveld; M J van den Bent; C J van Groeningen; B A Zonnenberg; K C Sneeuw; J J Heimans Journal: Neurology Date: 2001-01-09 Impact factor: 9.910
Authors: M Brada; K Hoang-Xuan; R Rampling; P Y Dietrich; L Y Dirix; D Macdonald; J J Heimans; B A Zonnenberg; J M Bravo-Marques; R Henriksson; R Stupp; N Yue; J Bruner; M Dugan; S Rao; S Zaknoen Journal: Ann Oncol Date: 2001-02 Impact factor: 32.976
Authors: M J van den Bent; F Keime-Guibert; A A Brandes; M J Taphoorn; J M Kros; F A Eskens; A F Carpentier Journal: Neurology Date: 2001-07-24 Impact factor: 9.910
Authors: K Hoang-Xuan; L Capelle; M Kujas; S Taillibert; H Duffau; J Lejeune; M Polivka; E Crinière; Y Marie; K Mokhtari; A F Carpentier; F Laigle; J M Simon; P Cornu; P Broët; M Sanson; J Y Delattre Journal: J Clin Oncol Date: 2004-08-01 Impact factor: 44.544
Authors: Stephanie N Bamberger; Chanchal K Malik; Markus W Voehler; Summer K Brown; Hope Pan; Tracy L Johnson-Salyard; Carmelo J Rizzo; Michael P Stone Journal: Chem Res Toxicol Date: 2018-08-31 Impact factor: 3.739
Authors: Jung-Young Kim; Jennifer G Jackman; Sarah Woodring; Frances McSherry; James E Herndon; Annick Desjardins; Henry S Friedman; Katherine B Peters Journal: Neurooncol Pract Date: 2019-02-04