Reactions 1292 - 13 Mar 2010

SAntineoplastics

Myelodysplastic syndrome and acute myeloidleukaemia: 6 case reports

Six women were hospitalised with myelodysplasticsyndrome (MDS) or acute myeloid leukaemia (AML)following breast cancer (BC) treatment [see table for patientcharacteristics]. Two patients had also been treated forovarian cancer (patients 4 and 6).

Initial treatment for BC consisted of mastectomy(patients 1 and 6), bilateral mastectomy (patients 4 and 5)or lumpectomy and radiation (patients 2 and 3). Adjuvantchemotherapy consisted of various antineoplasticsincluding cyclophosphamide, doxorubicin, paclitaxel,capecitabine, letrozole, tamoxifen, fluorouracil,trastuzumab [Herceptin] and methotrexate [dosages notstated]. Patient 6 did not receive adjuvant chemotherapyfor breast cancer but had received carboplatin andpaclitaxel for ovarian cancer; patient 4 had also receivedcarboplatin and paclitaxel for ovarian cancer [dosages notstated]. Time from chemotherapy to development of MDSor AML was 1–7 years, and all patients presented withsymptoms such as bruising, fatigue or fever. Subsequentabnormal haemograms prompted evaluation from theironcologists; MDS or AML were diagnosed from bonemarrow aspiration and biopsy. Cytogenetics were normalin patients 1 and 3; patients 2 and 5 had inversions ofchromosome 16; patient 4 had loss of chromosomes 5, 7, 9and 21, as well as trisomy 8; patient 6 had additions ofchromosomes 5, 6 and 11, and deletion ofchromosome 12. Additionally, patients 4, 5, and 6 werefound to have BRCA gene mutations.

The women were admitted for management [treatmentsand patient outcomes not stated].

Patient CharacteristicsPt/sex/ Chemotherapy Time to Type of AML orage (y) onset (y)a MDS

1/F/37 Cyclophosphamide, 2 FAB M4doxorubicin, paclitaxel,capecitabineb

2/F/65 Cyclophosphamide, 1 FAB M4 withdoxorubicin, paclitaxelb eosinophilia

3/F/70 Cyclophosphamide, 2 FAB M4doxorubicin, paclitaxel,letrozole, tamoxifenb

4/F/55 Paclitaxel, carboplatin;c 7 MDS RAEB 2 cyclophosphamide,methotrexate,fluorouracil,doxorubicinb

5/F/54 Cyclophosphamide, 2 FAB M4 withdoxorubicin, paclitaxel, eosinophiliatrastuzumabb

6/F/78 Paclitaxel, carboplatinc 1 FAB M4

FAB: French-American-British; RAEB: refractory anaemia with excessblastsa Time from chemotherapy to development of MDS or AMLb Treatment for breast cancerc Treatment for ovarian cancer

Cole M, et al. Acute myelogenous leukemia and myelodysplasia secondary tobreast cancer treatment: case studies and literature review. [Review] [28 refs].American Journal of the Medical Sciences 339: 36-40, No. 1, Jan 2010 -USA 803007272

1

Reactions 13 Mar 2010 No. 12920114-9954/10/1292-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved