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Therapy-Related Myeloid Neoplasms.

治疗相关的髓系肿瘤

Bueso-Ramos CE,Kanagal-Shamanna R,Routbort MJ,Hanson CA

Abstract

In the 2008 World Health Organization classification, cases of acute myeloid leukemia (AML) and myelodysplastic syndrome that arise after chemotherapy or radiation therapy for a primary neoplasm are considered together as therapy-related myeloid neoplasms (TR-MNs). This concept, however, is not universally accepted since there are confounding variables in attributing myeloid neoplasms to earlier therapies.
Cases in session 6 of the 2013 Workshop of the Society for Hematopathology/European Association for Haematopathology illustrated myeloid neoplasms thought likely to be TR-MNs, and discussed the differences and biologic similarities with de novo myeloid neoplasms.
We reviewed data showing that diagnosis of TR-MN alters patient outcome only in specific subsets. The session also included examples of therapy-related AML with recurrent genetic abnormalities, such as t(15;17), inv(16), and t(8;21), and reports were highlighted showing that patients with these neoplasms have clinical outcomes similar to patients with their de novo counterparts.
The study of TR-MNs will likely provide insight into the pathogenesis of de novo myeloid disease and may explain why some patients with cancer develop TR-MN and evidently have a higher genetic susceptibility, whereas most patients treated with the same agents do not. These studies will also result in critical reappraisal of current concepts related to TR-MNs.

摘要

   2008年世界卫生组织分类中,原发肿瘤化疗或放疗后出现的急性髓性白血病(AML)和骨髓增生异常综合征被归类为治疗相关髓系肿瘤(TR-MNs)。但这个观点还没有被普遍接受,因为早期治疗导致髓系肿瘤的过程有很多混杂因素存在。

   2013年血液病理学学会/欧洲血液病理学协会第6届研讨会上公布的髓类肿瘤病例有些像TR-MNs,会上还讨论了TR-MNs与原发髓系肿瘤的不同点及生物学相同点。

   我们分析数据发现,TR-MNs的诊断只改变了特定亚群患者的预后。会议还提到伴复发性遗传异常的治疗相关AML,如t(15; 17),inv(16)和t(8; 21),并特别指出,这类肿瘤患者与原发病例有类似临床预后。

   研究TR-MNs可以深入了解原发髓系疾病的发病机制,并且解释为什么一些癌症患者会发展为TR-MNs并且明显具有较高的遗传易感性,而大多数接受相同治疗的患者却并非如此。这些研究也使TR-MNs的相关观点得以重新认识。



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