secondary primary malignancies in multiple myeloma an old nemesis revisited二级主要恶性肿瘤在多发性骨髓瘤的老对手再现.pdfVIP

Hindawi Publishing Corporation Advances in Hematology Volume 2012, Article ID 801495, 9 pages doi:10.1155/2012/801495 Review Article Secondary Primary Malignancies in Multiple Myeloma: An Old Nemesis Revisited Jay Yang,1 Howard R. Terebelo,2 and Jeffrey A. Zonder1 1 Department of Oncology, Karmanos Cancer Institute and Wayne State University, Detroit, MI 48201, USA 2 Department of Internal Medicine, Providence Hospital, Southfield, MI 48075, USA Correspondence should be addressed to Jay Yang, yangj@ Received 15 December 2011; Revised 25 May 2012; Accepted 3 June 2012 Academic Editor: Umberto Vitolo Copyright © 2012 Jay Yang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The treatment of myeloma has undergone extraordinary improvements in the past half century. These advances have been accompanied by a concern for secondary primary malignancies (SPMs). It has been known for decades that extended therapy with alkylating chemotherapy agents, such as melphalan, carries an increased risk of therapy-related myelodysplastic syndrome and/or acute myeloid leukemia (t-MDS/AML), with a cumulative risk as high as 10–15%. High dose chemotherapy with autologous stem cell support became widely accepted for myeloma in the 1990s. Despite the use of high-doses of melphalan, the risk of t-MDS/AML with this procedure is estimated to be less than 5%, with much of this risk attributable to pretransplant therapy. Recently, lenalidomide has come under scrutiny for its possible association with SPMs. It is too soon to declare a causal relationship at this time, but there appears to be an increased number of S