• Kenzo Kosugi, Katsuya Saito, Wataru Takahashi, Yukina Tokuda, and Hideyuki Tomita.
• Department of Neurosurgery, National Hospital Organization Tochigi Medical Center, Tochigi, Japan. Electronic address: kensan03977@yahoo.co.jp.
• World Neurosurg. 2017 May 1; 101: 816.e11-816.e16.

BackgroundTemozolomide (TMZ) is now standard adjuvant therapy in combination with radiotherapy for patients with newly diagnosed malignant glioma. Treatment-related myelodysplastic syndrome and acute treatment-related leukemia (t-AML) associated with TMZ chemotherapy for patients with glioma is quite a rare complication.Case DescriptionA 43-year-old man with an anaplastic astrocytoma received radiation therapy synchronized with ranimustine and adjuvant TMZ chemotherapy for 15 cycles. Close follow-up magnetic resonance imaging of the head during TMZ chemotherapy showed no evidence of tumor progression. One year after the completion of TMZ chemotherapy, a bone-marrow aspiration was performed because the patient's white blood cell count decreased. He was diagnosed with t-AML based on the bone marrow examination, and then he was referred to the cancer center for the treatment of t-AML.ConclusionsIn this case study, we continued adjuvant TMZ therapy beyond the recommended 6 cycles. Currently, there is no consensus as to how long the adjuvant TMZ therapy should be continued for the treatment of residual tumor showing no apparent interval change. A new decision-making tool to assess the clinical benefits against the side effects for long-term adjuvant TMZ therapy is needed.Copyright © 2017 Elsevier Inc. All rights reserved.

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