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Spontaneous remission of 2-chlorodeoxyadenosine (2-CdA)-related secondary myelodysplastic syndrome in a patient with refractory Langerhans cell histiocytosis

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Abstract

Langerhans cell histiocytosis (LCH) is sometimes resistant to conventional chemotherapies, and treatment with 2-chlorodeoxyadenosine (2-CdA) is gaining importance as a salvage treatment for refractory or recurrent LCH. Secondary malignancies such as acute myelogenous leukemia and myelodysplastic syndrome (MDS) due to 2-CdA have recently been reported. However, there have been no reports to date of cases of 2-CdA-related secondary MDS in which spontaneous remission was achieved. Here, we report the case of a 1-year-old boy with an occipital tumor who was diagnosed with LCH by biopsy and underwent chemotherapy. However, the disease relapsed and became refractory to chemotherapy. He received 2-CdA treatment, which was effective. However 6 months after the start of treatment, he developed MDS with chromosomal abnormality of 7q−. After 1-year observation without any intervention, his hematological findings had returned to normal, and the chromosomal abnormality had also disappeared. To our knowledge, this is the first report of 2-CdA-related MDS with spontaneous hematological remission.

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References

  1. Stine KC, Saylors RL, Williams LL, Becton DL. 2-Chlorodeoxyadenosine (2-CdA) for the treatment of refractory or recurrent Langerhans cell histiocytosis (LCH) in pediatric patients. Med Pediatr Oncol. 1997;29:288–92.

    Article  PubMed  CAS  Google Scholar 

  2. Apollonsky N, Lipton JM. Treatment of refractory Langerhans cell histiocytosis (LCH) with a combination of 2-chlorodeoxyadenosine and cytosine arabinoside. J Pediatr Hematol Oncol. 2009;31:53–6.

    Article  PubMed  Google Scholar 

  3. Weitzman S, Wayne AS, Arceci R, Lipton JM, Whitlock JA. Nucleoside analogues in the therapy of Langerhans cell histiocytosis: a survey of members of the histiocyte society and review of the literature. Med Pediatr Oncol. 1999;33:476–81.

    Article  PubMed  CAS  Google Scholar 

  4. Jager G, Hofler G, Linkesch W, Neumeister P. Occurrence of a myelodysplastic syndrome (MDS) during first-line 2-chlorodeoxyadenosine (2-CdA) treatement of a low-grade gastrointestinal MALT lymphoma. Case report and review of the literature. Haematologica. 2004;89:e1–3.

    Google Scholar 

  5. Van Den Neste E, Louviaux I, Michaux JL, Delannoy A, Hagemeijer A, Scheiff JM, Bosly A, Straetmans N, Ferrant A. Myelodysplastic syndrome with monosomy 5 and/or 7 following therapy with 2-chloro-2′-deoxyadenosine. Br J Haematol. 1999;105:268–70.

    Google Scholar 

  6. Kroft SH, Tallman MS, Shaw JM, Thangavelu M, Peterson LC. Myelodysplasia following treatment of chronic lymphocytic leukemia (CLL) with 2-chlorodeoxyadenosine (2-CdA). Leukemia. 1997;11:170.

    Article  PubMed  CAS  Google Scholar 

  7. Laurence FM, Zulian GB, Cabrol C, Betticher DC. Myelodysplastic syndrome with biclonal monosomy 7 and trisomy 8 after treatment with cladribine (2-chloro-2-deoxyadenosine) and involved field radiation therapy. Cancer Genet Cytogenet. 1997;99:85–9.

    Article  Google Scholar 

  8. Delannoy A, Van den Neste E, Michaux JL, Bosly A, Ferrant A. Cladribine for Waldenstrom’s Macroglobulinaemia. Br J Haematol. 1999;104:933–4.

    Article  PubMed  CAS  Google Scholar 

  9. Kong LR, Huang CF, Hakimian D, Variakojis D, Klein L, Kuzel TM, Gordon LI, Zanzig C, Wollins E, Tallman MS. Long term follow-up and late complications of 2-chlorodeoxyadenosine in previously treated, advanced, indolent non-Hodgkin lymphoma. Cancer. 1998;82:957–64.

    Article  PubMed  CAS  Google Scholar 

  10. Parker TM, Klaassen RJ, Johnston DL. Spontaneous remission of myelodysplastic syndrome with monosomy 7 in a young boy. Cancer Genet Cytogenet. 2008;182:122–5.

    Article  PubMed  Google Scholar 

  11. Scheurlen W, Borkhardt A, Ritterbach J, Huppertz HI. Spontaneous hematological remission in a boy with myelodysplastic syndrome and monosomy 7. Leukemia. 1994;8:1435–8.

    PubMed  CAS  Google Scholar 

  12. Leung EW, Woodman RC, Roland B, Abdelhaleem M, Freedman MH, Dror Y. Transient myelodysplastic syndrome associated with isochromosome 7q abnormality. Pediatr Hematol Oncol. 2003;20:539–45.

    Article  PubMed  Google Scholar 

  13. Renneboog B, Hansen V, Heimann P, De Mulder A, Jannsen F, Ferster A. Spontaneous remission in a patient with therapy-related myelodysplastic syndrome (t-MDS) with monosomy 7. Br J Haematol. 1996;92:696–8.

    Article  PubMed  CAS  Google Scholar 

  14. Montella L, Insabato L, Palmieri G. Imatinib mesylate for cerebral Langerhans’-cell histiocytosis. N Eng J Med. 2004;351:1034–5.

    Article  CAS  Google Scholar 

  15. Henter JI, Karlen J, Calming U, Bernstrand C, Andersson U, Fadeel B. Successful treatment of Langerhans’-cell histiocytosis with etanercept. N Eng J Med. 2001;345:1577–8.

    Article  CAS  Google Scholar 

  16. Weitzman S, Braier J, Egeler RM, Grois N, Ladisch S, Potschger U, Webb D, Whitlock J, Arceri RJ. 2′-Chlorodeoxyadenosine (2-CdA) as salvage for Langerhans cell histiocytosis (LCH). Results of the LCH-S-98 protocol of the Histiocyte Society. Pediatr Blood Cancer. 2009;53(7):1271–6.

    Article  PubMed  Google Scholar 

  17. Imamura T, Sato T, Shiota Y, Kanegane H, Kudo K, Nakagawa S, Nakadate H, Tauchi H, Kamizono J, Morimoto A. Outcome of pediatric patients with Langerhans cell histiocytosis treated with 2 chlorodeoxyadenosine: a nationwide survey in Japan. Int J Hematol. 2010;91:646–51.

    Article  PubMed  CAS  Google Scholar 

  18. Yamada K, Yasui M, Sawada A, Inoue M, Nakayama M, Kawa K. Severe persistent bone marrow failure following therapy with 2-chlorodeoxyadenosine for relapsing juvenile xanthogranuloma of the brain. Pediatr Blood Cancer. 2012;58:300–2.

    Article  PubMed  Google Scholar 

  19. Egeler RM, Neglia JP, Arico M, Favara BE, Heitger A, Nesbit ME, Nicholson HS. The relation of Langerhans cell histiocytosis to acute leukemia, lymphomas, and other solid tumors. The LCH-Malignancy Study Group of the Histiocyte Society. Hematol Oncol Clin N Am. 1998;12:369–78.

    Article  CAS  Google Scholar 

  20. Petti MC, Latagliata R, Breccia M, Alimena G, Spadea A, D’Andrea M, Mancini M, Spiriti MAA, Mandelli F. Spontaneous remission in adult patients with de novo myelodysplastic syndrome: a possible event. Haematologica. 2001;86:1277–80.

    PubMed  CAS  Google Scholar 

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Correspondence to Daisuke Suzuki.

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Suzuki, D., Kobayashi, R., Sano, H. et al. Spontaneous remission of 2-chlorodeoxyadenosine (2-CdA)-related secondary myelodysplastic syndrome in a patient with refractory Langerhans cell histiocytosis. Int J Hematol 97, 782–785 (2013). https://doi.org/10.1007/s12185-013-1343-7

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  • DOI: https://doi.org/10.1007/s12185-013-1343-7

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