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Secondary myelodysplastic syndrome following long-term treatment with azathioprine in patients with multiple sclerosis

Department of Neurology, University Hospital Essen, Essen, Germany, neuroweb{at}uni-essen.de

Sabine Knipp

Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany

T im Ramczykowski

Department of Neurology, University Hospital Essen, Essen, Germany

Susanne Vago

Department of Neurology, University Hospital Essen, Essen, Germany

Ulrich Germing

Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany

H. Chr. Diener

Department of Neurology, University Hospital Essen, Essen, Germany

Volker Limmroth

Department of Neurology, University Hospital Essen, Essen, Germany

Azathioprine (Aza) is a widely used immunosuppressive drug in multiple sclerosis (MS) treatment. Recently, the incidence of secondary myelodysplastic syndromes (sMDS) associated with a poor prognosis was found to be elevated in patients treated with Aza for non-malign disorders. Three hundred and seventeen MS patients were retrospectively analysed and complete blood counts were examined for those exposed to Aza. We identified one case of sMDS (cumulative dose 627 g) in a young patient and two further malignancies (cumulative doses 27 g and 54 g) in the Aza group (n=81; 3.7%). In the non-Aza (n=236) group, five malignancies (2.1%, P=0.419) were identified. Including our patient, four cases of sMDS after long-term Aza therapy in MS have been reported so far. Cases suggest a time- and dose-dependent risk of sMDS in long-term therapy of MS with Aza. Long-term Aza therapy needs careful monitoring.

Key Words: azathioprine • multiple sclerosis • myelodysplastic syndrome • treatment

Multiple Sclerosis, Vol. 12, No. 3, 363-366 (2006)
DOI: 10.1191/135248506ms1307cr


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