M. Mittelman et al., SECONDARY MYELODYSPLASTIC-SYNDROME IN MULTIPLE-MYELOMA - A STUDY OF 9PATIENTS WITH AN ATTEMPT TO DETECT MYELOMA PATIENTS AT RISK, Haematologia, 26(2), 1994, pp. 67-74
Over a follow-up period of ten years, nine of our 100 patients with mu
ltiple myeloma (MM), developed myelodysplastic syndrome (MDS, preleuka
emia). MDS occurred 19-156 (median 35) months from the diagnosis of MM
. Six patients presented with pancytopenia and no patients had active
MM at the time of MDS diagnosis. Three patients were defined as having
refractory anaemia (RA) and six as refractory anaemia with excess bla
sts (RAEB) or RAEB in transformation (RAEBT), according to the FAB cla
ssification. The clinical course is characterized by increasing red bl
ood cell and platelet transfusion requirements, recurrent infections a
nd bleeding episodes. All patients, except for one, died within 3 to 8
(median 5) months from MDS diagnosis. The causes of death were sepsis
or bleeding; three patients underwent leukaemic transformation. Thus,
the clinical course of this small group of myeloma patients who devel
oped secondary MDS (sMDS), was similar to other series of patients wit
h sMDS. Serial bone marrow examinations suggest an initial hypercellul
ar phase, followed by a rapidly evolving preterminal hypocellular marr
ow. In an attempt to detect MM patients at risk of developing sMDS, th
e epidemiological (including ethnic), clinical and laboratory data of
the 9 MDS patients at the time of the MM presentation were reviewed an
d compared to the other MM patients. No significant differences were o
bserved between the two groups in most parameters, except for two. All
MDS patients were Ashkenazi Jews and no patients of Sepharadic origin
developed MDS. Also, no IgA-myeloma patient developed MDS. If these f
indings are confirmed in a larger series, it may point to subgroups at
risk which may require a different approach. We also tested the well-
known association of sMDS in MM patients with the administration of al
keran (melphalan) to these patients. No difference was found in the cu
mulative dose of alkeran used in our 9 MDS patients, compared with oth
er myeloma patients. On the other hand, the MDS patients in our series
received higher cumulative dose of prednisone per person then the oth
ers. Although this is a preliminary observation in a small number of p
atients, taking these data together with some recent reports associati
ng corticosteroids with leukaemogenesis as well as the known effects o
f these agents on the immune system, it is tempting to speculate that
corticosteroids may play a role in the pathogenesis of this complicati
on in patients with MM.