levoleucovorin and Myelodysplastic-Syndromes

Therapy-related myelodysplasticsyndrome(t-MDS)has been reported to occur after treatment with cytotoxic agents and radiation. Here, we report a case of t-MDS following oxaliplatin(L-OHP)exposure, which was successfully treated with azacitidine(AZA). A 71-year-old man was referred to our department because of pancytopenia. He had been diagnosed with rectal cancer(cT4aNXM0, stage II B-III C, RAS gene status wild-type)3 years ago and had received 8 courses of capecitabine(CAP)and L-OHP(XELOX regimen), followed by 48 courses of CAP and bevacizumab. Before referral, recurrence of rectal cancer was detected using CT after the last course of chemotherapy. A bone marrow examination revealed multilineage dysplasia and 9.0%myeloblasts. Cytogenetic analysis disclosed a chromosome 7 abnormality. The diagnosis of t- MDS was made and treatment with AZA was initiated. Subsequently, temporary but significant hematological improvements were observed, which enabled the patient to receive additional palliative radiation therapy against the locally relapsed rectal cancer. AZA might be useful in t-MDS because of its efficacy and low toxicity.

Topics: Aged; Antimetabolites, Antineoplastic; Azacitidine; Combined Modality Therapy; Fatal Outcome; Humans; Leucovorin; Male; Myelodysplastic Syndromes; Neoplasm Metastasis; Organoplatinum Compounds; Oxaliplatin; Rectal Neoplasms

We report two cases of secondary myelodysplastic syndrome (SMDS) which followed successful treatment of a primary malignancy with high-dose chemotherapy supported by reinfusion of autologous stem cells. The SMDS was diagnosed 24 months and 40 months, respectively, following autografting. Both patients lived for 7 months after the diagnosis of SMDS. Our cases support the view that there is an increased risk of SMDS/acute leukemia following autologous marrow transplantation.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Marrow Transplantation; Combined Modality Therapy; Cyclophosphamide; Dose-Response Relationship, Drug; Doxorubicin; Etoposide; Humans; Leucovorin; Lymphoma; Male; Methotrexate; Myelodysplastic Syndromes; Prednisone; Procarbazine; Rectal Neoplasms; Risk Factors; Seminoma; Testicular Neoplasms; Transplantation, Autologous; Vincristine

Topics: Bone Marrow; Child; Cytological Techniques; Humans; Infusions, Intravenous; Interphase; Leucovorin; Methotrexate; Myelodysplastic Syndromes; Pilot Projects; Precursor Cell Lymphoblastic Leukemia-Lymphoma