講演情報
[P19-8]Secondary MDS harboring t(16;21)(q24;q22.1) and PPM1D mutation after chemotherapy for peritoneal cancer
○河野 徳明, 菊池 郁夫 (県立宮崎病院 内科)
Although carboplatin, paclitaxcel and olaparib plays major role in the treatment for peritoneal cancer, the development of secondary malignancy has been a serious problems to resolve. Furthermore, the precise mechanism of secondary malignancy has been unclear. A 62-year-old woman after carboplatin, paclitaxcel and olaparib therapy for peritoneal cancer developed secondary MDS with multi-lineage dysplasia. Chromosomal analysis and genetic analysis showed the findings of t(16;21)(q24;q22.1) and PPM1D mutation. Prior chemotherapy for peritoneal cancer and the genetic findings of t(16;21)(q24;q22.1) and PPM1D mutation, we finally made diagnosed with secondary MDS. These treatments with azacitidine led the case to CR. The MRD of MDS was monitored by RT-PCR analysis of RUNX1-CBFA2T3. Subsequent treatment including allogeneic HSCT was contra-indicated because of organ dysfunction by prior chemotherapy and high-tighter of DSA. However, the case suddenly progressed from secondary MDS into MDS-overt AML after 12 courses of azacitidine. Thus, the case was treated with azacitidine and venetoclax. Consistent with previous reports, our case showed that chromosomal findings and genetic findings of t(16;21)(q24;q22.1) and PPM1D mutation may strongly related to the secondary malignancy after prior chemotherapy for peritoneal cancer.In conclusion, the case with prior chemotherapy such as carboplatin, paclitaxcel and olaparib for peritoneal cancer should be carefully followed to monitor the development of secondary MDS/AML in clinical practice.