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Japanese Journal of Clinical Oncology Advance Access originally published online on September 19, 2005
Japanese Journal of Clinical Oncology 2005 35(10):622-625; doi:10.1093/jjco/hyi153
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© 2005 Foundation for Promotion of Cancer Research

Case Report

Myelodysplastic Syndrome with Complex Karyotypic Abnormality in a Patient with Waldenström's Macroglobulinemia after Sequential Treatment with Chlorambucil and Fludarabine

Sang Joon Shin1, Sung Ho Chun1, Kyeong Ok Kim1, Min Kyoung Kim1, Kyung Hee Lee1, Myung Soo Hyun1 and Hee Soon Cho2

1 Division of Oncology-Hematology, Department of Internal Medicine and 2 Department of Laboratory Medicine, Yeungnam University College of Medicine, Daegu, Korea

For reprints and all correspondence: Myung Soo Hyun, Division of Oncology-Hematology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea. E-mail: hms{at}med.yu.ac.kr

Received March 30, 2005; accepted August 8, 2005

A therapy-related myelodysplastic syndrome (t-MDS) during the course of Waldenström's macroglobulinemia (WM) has been observed in rare patients. In most of them, the condition developed after treatment with alkylating agents. We experienced a 65-year-old male patient who was diagnosed as WM. He was treated with intermittent oral chlorambucil for 12 months and three cycles of fludarabine, and complete response was achieved after fludarabine treatment. During routine outpatient follow-up, severe anemia occurred. His bone marrow aspirate showed dysplastic hemopoiesis with ringed sideroblasts and siderocytes, which is consistent with MDS (refractory anemia with ringed sideroblasts). Cytogenetic analysis showed complex chromosomal abnormalities including 5q deletion, 12p deletion and monosomy 18. When decision is made to treat WM with chlorambucil and/or fludarabine, a potential risk for t-MDS or therapy-related acute myeloid leukemia should be considered and a close hematologic monitoring is needed.

Key Words: Waldenström's macroglobulinemia • myelodysplastic syndrome • chlorambucil • fludarabine


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