부산대학교 도서관

AML following adjuvant CMF for breast cancer is rare, late, and associated with total dose of cyclophosphamide and further leukaemogenic therapy. The 3M combination (mitoxantrone, methotrexate, mitomycin offers equal efficacy to CMF in advanced disease and more acceptable toxicity. The 2M combination omits mitomycin and is felt to have equal efficacy. From 1986–92, 3M and 2M were given as adjuvant therapies to 60 premenopausal patients aged 32–54 years (median 42). They had node-positive disease or a local recurrence resected without systemic disease. Thirty had 3M, (projected total doses per m2BSA of mitomycin 32mg, methotrexate 240mg and mitoxantrone 64mg). Mitomycin was given every six weeks, the other drugs every three weeks over 24 weeks. Thirty received 2M (projected total doses of 280mg/m2for methotrexate and 96mg/m2mitoxantrone), every three weeks over 24 weeks. Percent projected dose received was 88.6% mitomycin, 92.9% methotrexate and 96% mitoxantrone. From 1993 reports of early AML following 3M in advanced breast cancer appeared and we studied this phenomenon following 3M and 2M in the adjuvant setting. Two cases of AML FAB M2 and M4EO without detected cytogenetic abnormalIties have occurred 18 and 23 months following 2M therapy. Neither patient had other leukaemogenic treatment. Hitherto mitomycin has been considered the major risk factor but given the acknowledged risk associated with topoisomerase I agents, mitoxantrone must be considered a likely causative agent here and its use in adjuvant treatment regimens cannot be recommended.