Poor survival of treatment-related acute nonlymphocytic leukemia.
Population-based data on more than 1 million patients registered in the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute, 1973 to 1984, were analyzed to determine the survival of patients with de novo acute nonlymphocytic leukemia (ANLL) and following a first primary tumor treated (with chemotherapy and/or radiation therapy) or untreated. Cases that occurred within 12 months of the first malignant neoplasm were excluded. Survival was estimated using Cox proportional-hazards modeling, with age, sex, and specific type of ANLL as covariates. The 6271 patients with de novo ANLL had an estimated 12-month survival of 30%, while the 107 patients with treatment-related ANLL (radiation therapy, 60; chemotherapy, 29; both, 18) had an estimated 12-month survival of 10%. This is not due to lingering effects of the first tumor since ANLL following solid tumors not treated with chemotherapy or radiation therapy (118 cases) has similar survival (estimated 12-month survival, 36%) as de novo ANLL. We conclude that ANLL that occurs after chemotherapy or radiation therapy is biologically more aggressive and/or resistant to therapy than spontaneous ANLL. This provides a rationale for current studies on treatment-induced cellular changes and on more aggressive therapy for these patients.
Neugut
A I
AI
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
Robinson
E
E
Nieves
J
J
Murray
T
T
Tsai
W Y
WY
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced / Q000209:etiology / Q000401:mortality*; D007953:Leukemia, Radiation-Induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries; D016019:Survival Analysis
D000970:Antineoplastic Agents