title: Secondary tumours following etoposide containing therapy for germ cell cancer.
abstract: BACKGROUND
  Reports have implied etoposide as the cause of secondary leukaemia in patients treated for germ cell cancer.
  
  
  METHODS
  Between 1979 and 1992, 679 male patients with germ cell cancer received etoposide containing chemotherapy.
  
  
  RESULTS
  Six of 679 patients developed acute myeloid leukaemia (relative risk 150; CI: 55-326). None of these patients had a primary mediastinal germ cell tumour and only 1 patient received previous radiotherapy. The median interval between the onset of cytotoxic treatment and the development of leukaemia was 27 months. The FAB M4 morphology was seen in 4 of 6 cases.
  
  
  CONCLUSIONS
  The benefit of etoposide containing protocols outweigh the risk of leukaemia in patients with intermediate or high risk disease, however in patients with good risk disease non-etoposide containing protocols should be explored.
authors.affiliation: Royal London Hospital, U.K.
authors.forename: C
authors.initials: C
authors.lastname: Boshoff
authors.forename: R H
authors.initials: RH
authors.lastname: Begent
authors.forename: R T
authors.initials: RT
authors.lastname: Oliver
authors.forename: G J
authors.initials: GJ
authors.lastname: Rustin
authors.forename: E S
authors.initials: ES
authors.lastname: Newlands
authors.forename: R
authors.initials: R
authors.lastname: Andrews
authors.forename: M
authors.initials: M
authors.lastname: Skelton
authors.forename: L
authors.initials: L
authors.lastname: Holden
authors.forename: J
authors.initials: J
authors.lastname: Ong
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D018237:Germinoma / Q000188:drug therapy*; D006801:Humans; D007951:Leukemia, Myeloid / Q000139:chemically induced*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced*; D013736:Testicular Neoplasms / Q000188:drug therapy*; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D003561:Cytarabine; D001761:Bleomycin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate