Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma with fludarabine, mitoxantrone, and dexamethasone (FND) plus rituximab and interferon alpha

• Published in: Blood 2005-06, Vol.105 (12), p.4573-4575
• Main Authors: McLaughlin, Peter, Estey, Elihu, Glassman, Armand, Romaguera, Jorge, Samaniego, Felipe, Ayala, Ana, Hayes, Kimberly, Maddox, Anne Marie, Preti, H. Alejandro, Hagemeister, Fredrick B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chromosome Aberrations; Chromosomes, Human, Pair 7; Clinical Observations, Interventions, and Therapeutic Trials; Combined Modality Therapy; Dexamethasone - administration & dosage; Disease-Free Survival; DNA Damage; Drug toxicity and drugs side effects treatment; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Immunotherapy - methods; Interferon-alpha - administration & dosage; Leukemia, Myeloid, Acute - chemically induced; Leukemia, Myeloid, Acute - diagnosis; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma - drug therapy; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Mitoxantrone - administration & dosage; Monosomy; Myelodysplastic Syndromes - chemically induced; Myelodysplastic Syndromes - diagnosis; Pharmacology. Drug treatments; Remission Induction; Rituximab; Time Factors; Vidarabine - administration & dosage; Vidarabine - analogs & derivatives
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2004-08-3035

Treatment-related myelodysplasia (t-MDS) occurs less frequently with the nucleoside analogs than with DNA-damaging agents such as alkylators or topoisomerase II inhibitors. In a chemoimmunotherapy trial conducted between 1997 and 2003 in patients with stage IV indolent lymphoma, 202 patients were treated and 8 have developed MDS between 1 and 5 years after therapy, including 4 who received only fludarabine, mitoxantrone, and dexamethasone (FND) for 6 to 8 courses, with or without rituximab, followed by interferon alpha (IFN-α). Complex cytogenetic abnormalities were present in all patients. Abnormalities of chromosome 7 were present in 6 of the 8 patients, 3 of whom received only FND ± rituximab and IFN-α. The abnormalities of chromosome 7 were monosomy 7 in 4 patients (1 of which had add 7p in the remaining chromosome); 1 del 7q; and 1 der 7. MDS with features classically associated with DNA-damaging agents can occur following therapy with FND, with or without rituximab, and IFN-α. (Blood. 2005;105:4573-4575)