子宮平滑筋肉腫の術後転移再発に対する化学療法および緩和的放射線療法後に治療関連慢性骨髄性白血病を発症した一例

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Chemotherapy or radiation therapy for malignant tumors can induce leukemia, known as therapy-related leukemia. We report a case of therapy-related chronic myelogenous leukemia that developed after palliative radiotherapy and chemotherapy for recurrent metastatic uterine leiomyosarcoma. The patient, a 45-year-old Japanese woman was referred to our institution for a 15-cm uterine mass. We performed total hysterectomy. One year after the operation, we found an osteolytic tumor in the lumbar vertebra and left supraclavicular lymphadenopathy. Based on further pathological evaluation of the bone tumor, the uterine leiomyosarcoma had recurred and metastasized to the lumbar vertebra and left supraclavicular lymph node. After palliative radiation to the lumbar spine following posterior lumbar spinal fusion, she was administered adriamycin, gemcitabine with docetaxel, and ifosfamide, resulting in partial remission. One years later, her white blood cell count were increased to 71000 / μL. Bone marrow pathology demonstrated an increase in neutrophils at all stages of maturation and chromosomal examination led to the diagnosis of chronic-phase chronic myelogenous leukemia. She was treated using nilotinib, a tyrosine kinase inhibitor, and achieved the optimal course without recurrence. However, the primary uterine leiomyosarcoma was poorly controlled, with metastases in the brain, left femur, and left foot bone. During follow-up after chemotherapy and radiation therapy for malignant tumors, it is important to regularly measure the complete blood count and biochemical markers keeping in mind not only recurrence of the primary tumor, but also the development of secondary malignancy such as treatment-related leukemia.

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