MIJELODISPLASTIČNI SINDROM U BOLESNICE S NELIJEČENOM KRONIČNOM LIMFOPROLIFERATIVNOM NEOPLAZMOM

Ana Planinc-Peraica, Ana Reschner, Morana Kosanović-Bajić, Inga Mandac Rogulj, Gordana Kaić, Marin Kursar, Marko Martinović, Slobodanka Ostojić Kolonić, Delfa Radić-Krišto

U bolesnika s kroničnom limfoproliferativnom bolesti (LPB) veća je učestalost nastanka sekund-arnih neoplazma. Istodobna pojava limfoproliferativne neoplazme (LPN) i mijelodisplastičnog sindroma (MDS) vrlo je rijetka. Druga hematološka neoplazma dijagnosticira se slučajno tijekom kontrola ili pri dodatnim analizama zbog nesukladnih kliničkih ili laboratorijskih nalaza. Prikazu-jemo dijagnostički postupak, tijek bolesti i liječenje 65-godišnje bolesnice s kroničnom limfopro-liferativnom neoplazmom i MDS-om sa suviškom blasta tipa 2 (MDS-EB2). Vodeći nalaz bila je neutropenija, a tek su citološkim analizama koštane srži i periferne krvi dijagnosticirane navedene neoplazme. Liječenje jedne i druge hematološke neoplazme nije dalo zadovoljavajuće rezultate i MDS je progredirao u akutnu mijeloičnu leukemiju. U bolesnika s limfoprolifera-tivnom neoplazmom i citopenijom valja tragati za mogućim drugim uzrocima takvih aberantnih nalaza. Pri liječenju tih bolesnika razumno je liječiti dominantnu bolest.

High frequency of second malignancies is observed in chronic lymphoproliferative disease (LPD) patients. The simultaneous occurrence of myelodysplastic syndrome (MDS) with untreated LPD is extremely rare. Second haematological neoplasms are usually diagnosed incidentally during a routine clinical check-up, or due to discordant clinical or laboratory findings. We are reporting diagnostic procedures, clinical course, and treatment of a 65-year-old woman with chronic lym-phoproliferative neoplasm and MDS with excess of blasts type 2 (MDS-EB2). Neutropenia was the most aberrant finding. A diagnosis of two malignant haematological neoplasms was done by cytological analysis and immunophenotyping of bone marrow and peripheral blood cells. In spite of treating both neoplasms no satisfactory results were achieved and MDS progressed to acute myeloid leukaemia. In patients with lymphoproliferative neoplasms and cytopenias it is im-portant to find out other causes of these laboratory findings. In such patients the dominant disease should be treated. A concomitant MDS should be suspected and examined.