Acute Myelogenous Leukemia Early Developing during Postoperative Chemotherapy for Gastric Cancer with TS-1

Yoshikazu Yagi, Tadao Ishikawa, Kiichiro Okamoto, Tsuyoshi Sato, Tohru Ichihara, Yasushi Ikeda¹⁾, Atsuko Kitamura²⁾ and Masafumi Ito²⁾

Department of Surgery and Department of Internal Medicine¹⁾,
National Hospital Organization Toyohashi Hospital
Department of Pathology of Biological Response, Nagoya University Graduate School of Medicine²⁾

A 71-year-old man requiring further examination following mass gastric screening in June 2003 was diagnosed with gastric cancer in the form of a type 4 tumor in gastrointestinal endoscopy. We performed distal gastrectomy in the middle of August but could not completely resect the cancer due to lymph node metastasis to No.14a and 15, although we found neither liver metastasis nor carcinomatous peritonitis. TS-1 at a dose of 100 mg/day was started as postoperative chemotherapy from postoperative day (POD) 21. 24 days after TS-1 administration, the man reported wooziness and we found pancytopenia in a peripheral blood examination, diagnosed as the myelosuppression caused by TS-1. TS-1 was discontinued and pancytopenia symptoms decreased. The man suffered a fever of 39°C at the beginning of November and was found to have recurrent pancytopenia. Bone marrow aspiration showed acute type M4 myelogenous leukemia in the French-American-British classification. Despite chemotherapy with cytarabine at a dose of 40 mg/day, he died of the intracerebral bleeding in mid November after rapid and dramatic postoperative progression about 3 months.

Key words
acute myelogenous leukemia, gastric cancer, TS-1

Reprint requests
Yoshikazu Yagi Department of Surgery, Biyo Public Hospital
148 Yamanoura, Jimokuji, Jimokuji-cho, Ama-gun, 490-1111 JAPAN

Accepted
May 31, 2006

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