内容紹介
Summary
Therapy-related myelodysplastic syndrome(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 ⅡB-ⅢC, 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.
要旨
症例は71歳,男性。X-3年1月,結腸穿孔を契機に直腸癌(cT4aNXM0,stageⅡB～ⅢC,RAS遺伝子変異野生型)と診断した。術後に放射線療法,oxaliplatinを含む化学療法を実施した。X年9月ごろより汎血球減少があり,精査の結果,monosomy 7の染色体異常を有する治療関連骨髄異形成症候群(therapy-related myelodysplastic syndrome: t-MDS)の診断となった。今回われわれはt-MDSに対してazacitidine投与により,約1年の延命が可能であった1例を経験したので報告する。
目次
Therapy-related myelodysplastic syndrome(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 ⅡB-ⅢC, 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.
要旨
症例は71歳,男性。X-3年1月,結腸穿孔を契機に直腸癌(cT4aNXM0,stageⅡB～ⅢC,RAS遺伝子変異野生型)と診断した。術後に放射線療法,oxaliplatinを含む化学療法を実施した。X年9月ごろより汎血球減少があり,精査の結果,monosomy 7の染色体異常を有する治療関連骨髄異形成症候群(therapy-related myelodysplastic syndrome: t-MDS)の診断となった。今回われわれはt-MDSに対してazacitidine投与により,約1年の延命が可能であった1例を経験したので報告する。