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 Blood, 15 June 2005, Vol. 105, No. 12, pp. 4573-4575.
Prepublished online as a Blood First Edition Paper on March 1, 2005; DOI 10.1182/blood-2004-08-3035.

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Submitted August 5, 2004
Accepted January 12, 2005

Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma with Fludarabine, Mitoxantrone, Dexamethasone (FND) plus Rituximab and Interferon Alfa

Peter McLaughlin*, Elihu Estey, Armand Glassman, Jorge Romaguera, Felipe Samaniego, Ana Ayala, Kimberly Hayes, Anne M Maddox, H A Preti, and Fredrick B Hagemeister

Department of Lymphoma/Myeloma, UT MD Anderson Cancer Center, Houston, TX, USA
Department of Leukemia, UT MD Anderson Cancer Center, Houston, TX, USA
Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, USA
Department of Laboratory Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
University of Arkansas Medical School, Little Rock, AR, USA

* Corresponding author; email: pmclaugh{at}mdanderson.org.

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


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