Therapy-related leukemia. A report of five patients and a review of the literature.
5 patients developed acute nonlymphocytic leukemia (ANLL) 2-4 years following the use of various cytotoxic agents for other primary disease. Alkylating agents were responsible for development of ANLL in 3 patients while mitomycin-C and methotrexate appear to be linked with leukemia transformation in the remaining 2 patients. 3 patients had a prolonged preleukemic phase preceding ANLL. Pancytopenia observed in 4 of 5 patients favors drug-induced stem cell damage leading to relatively resistant leukemia. Although the incidence of secondary leukemia is not very high, careful use of cytotoxic agents is needed to minimize therapy-linked neoplasms.
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D006801:Humans; D007948:Leukemia, Monocytic, Acute / Q000139:chemically induced*; D008297:Male; D008558:Melphalan / Q000009:adverse effects; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D008937:Mitomycins / Q000009:adverse effects; D011379:Prognosis
D000970:Antineoplastic Agents; D008937:Mitomycins; D003520:Cyclophosphamide; D008558:Melphalan; D008727:Methotrexate