Zusammenfassung
Alkylanzien und Topoisomerase-II-Hemmstoffe können Therapie-induzierte akute myeloische Leukämien und Myelodysplasien auslösen. Die Häufigkeit des Auftretens hängt von der Art der verwendeten Substanz, ihrer Dosierung und der Behandlungsdauer ab. Mit den in der adjuvanten Therapie des Mammakarzinoms üblicherweise verwendeten Therapieprotokollen, wie dem CMF- oder AC-Schema, liegt die Leukämierate nach 10 Jahren bei 0,2 bis 0,5 %. Eine Intensivierung der Chemotherapie oder zusätzliche strahlentherapeutische Maßnahmen führen zu einer deutlichen Zunahme der Leukämieinzidenz. Die schlechte Prognose Therapie-induzierter Leukämien und Myelodysplasien begründet die Forderung nach einer möglichst präzisen Identifikation von Patienten, die von adjuvanten Therapiemaßnahmen tatsächlich profitieren.
Abstract
Alkylating agents and topoisomerase II inhibitors are mutagenic cytotoxic drugs which may induce therapy-related acute myeloid leukemia or myelodysplasia. The frequency of these complications depends on the type of agent used, its dosage, and the duration of treatment. Commonly used protocols for adjuvant chemotherapy of breast cancer, such as the CMF or AC protocols, are associated with a leukemia rate of 0.2 to 0.5 % after 10 years. Intensification of chemotherapy or additional radiotherapy lead to a significant increase in the incidence of leukemia. The prognosis of therapy-related leukemia is dismal. Therefore, it appears mandatory to restrict adjuvant chemotherapy to those patients who are the most likely to benefit from it.
Schlüsselwörter
Chemotherapie - Leukämie - Mammakarzinom - Myelodysplasie - Strahlentherapie
Key words
chemotherapy - leukemia - breast cancer - myelodysplasia - radiotherapy
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