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Report of a Case and Results of Morphologic, Cytogenetic, and Bone Marrow Culture Studies in Long-term Survivors

S. Paul Dang, MD, FACP; Bruce A. Liberman, MD; Frances A. Shepherd, MD, FRCP(C); Hans Messner, MD, FRCP(C); Mary Tweeddale, MD, FRCP(C); H. Allen Gardner, MD, FRCP(C); Terrance Colgan, MD, FRCP(C); Toby H. Rose, MD; William K. Evans, MD, FRCP(C)

Arch Intern Med. 1986;146(9):1689-1694.

Abstract
• The bone marrow of 11 patients with small-cell lung cancer, who survived more than two years following combined-modality therapy, was subjected to morphologic, cytogenetic, and bone marrow culture studies. One patient, after a prodrome of anemia and thrombocytopenia, developed acute leukemia 60 months after the start of chemotherapy. Four months before frank leukemia developed, bone marrow culture studies showed a marked inability to form colonies. Cytogenetic studies demonstrated an abnormal clone of cells that included the deletion of the long arm of chromosome 5. No morphologic abnormalities were noted in the bone marrow of any other long-term survivor; however, the mean corpuscular volume of peripheral red blood cells was greater than normal in three of four patients who remain alive and disease free. In one of these patients marrow culture studies also failed to grow colonies. The other patients showed a decreased ability to form multilineage colonies and colonies of the granulocyte-macrophage lineage in vitro compared with a control population. All patients showed some degree of aneuploidy on cytogenetic analysis; in two cases approximately 50% of cells were aneuploid. However, no clonal abnormality was detected in any patient. Follow-up for the development of secondary acute leukemia and other long-term complications continues in these patients.

(Arch Intern Med 1986;146:1689-1694)

Author Affiliations
From the Departments of Medicine (Drs Dang, Liberman, Shepherd, Tweeddale, and Evans), and Pathology (Drs Gardner, Colgan, and Rose), Toronto General Hospital, and the Ontario Cancer Institute, University of Toronto (Dr Messner). Dr Evans is a Clinical Trials Scholar of the National Cancer Institute of Canada.

Footnotes
Accepted for publication Jan 22, 1986.

Reprint requests to Ottawa Regional Cancer Centre, 190 Melrose Ave, Ottawa, Ontario, Canada K1Y 4K7 (Dr Evans).

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