Reduced-Intensity Allogeneic Stem Cell Transplantation for Co-Emergence of Chemotherapy-Refractory Follicular Lymphoma and Therapy-Related Myelodysplastic Syndrome

Abstract

A 54-year-old male was diagnosed with follicular lymphoma in September 2003. Despite multiple chemotherapies, including autologous hematopoietic stem cell transplantation (HSCT) with high-dose chemotherapy, the disease eventually relapsed. Additionally, bone marrow analysis revealed the co-emergence of therapy-related myelodysplastic syndrome (t-MDS) in February 2012. In March 2012, we performed related allogeneic HSCT for the treatment of both malignancies. This strategy was successful and the patient has remained free from both malignancies for 23 months. Allogeneic HSCT is a potent curative therapeutic option for both t-MDS and refractory follicular lymphoma.

A Case of Coexistence of Bone Marrow-involved Refractory Marginal Zone B-Cell Lymphoma and Therapy-related Myelodysplastic Syndrome

“…The chemotherapeutic regimen of our patient included the alkylating agent cyclophosphamide, and it took 67 months from the time of exposure to chemotherapy until the development of t-MDS. Alkylating agents or radiotherapy typically cause t-MDS and induce chromosomal abnormalities involving chromosomes 5 (-5,del(5q)) and 7 (-7,del(7q)) [3,8]. Our patient showed a complex karyotype, including monosomy 7.…”

“…Our patient showed a complex karyotype, including monosomy 7. In contrast, t-MN secondary to topoisomerase II inhibitors is associated with 11q23 or 21q22 abnormalities [3].…”

“…It is generally known that t-MNs secondary to alkylating agents appear 4 to 7 yr after the exposure, whereas t-MNs secondary to topoisomerase II inhibitors appear after the shorter period of 1 to 5 yr [3,6]. The chemotherapeutic regimen of our patient included the alkylating agent cyclophosphamide, and it took 67 months from the time of exposure to chemotherapy until the development of t-MDS.…”

“…Treatment options for t-MDS are limited, and allogeneic RIC-HSCT is a curative option [3]. NHL is the most common hematologic malignancy in Korea, and MZL accounts for about 17% of Korean B-cell lymphoma cases [9,10].…”

“…There have been some reports on the coexistence of BM-involved refractory lymphoma and t-MDS [3,12]. In a study of 17 patients with lymphoid malignancy and concurrent t-MDS, the median relapse-free survival and median overall survival was 4.3 months and 6.2 months, respectively [12].…”