title: Secondary acute myelogenous leukemia following safe exposure to etoposide.
abstract: OBJECTIVE
  To present two patients as illustrations of the risk of developing secondary acute myelogenous leukemia (sAML) when theoretically safe doses of etoposide (VP-16) are used.
  
  
  METHODS
  Patient no. 1 was a 15-year-old white girl diagnosed with stage IIa Hodgkin's disease. She was treated with a combination of vincristine, doxorubicin, bleomycin, and VP-16 (2 g/m2 total) over 4 months, followed by 25.5 Gy of involved-field radiotherapy. Patient no. 2 was an 11-year-old white boy diagnosed with virus-associated hemophagocytic syndrome (VAHS). He was treated with VP-16 intravenously (IV) and orally (0.3 g and 2.8 g/m2, respectively).
  
  
  RESULTS
  Patient no. 1 developed AML 16 months from the diagnosis of Hodgkin's disease. Patient no. 2 developed AML 26 months from diagnosis. Both bone marrows were consistent with French-American-British (FAB) M4 disease. Both patients had abnormalities of the long arm of chromosome 11.
  
  
  CONCLUSIONS
  The use of low-dose or oral VP-16 can be associated with the development of sAML. Clinicians should be cautious in the use of VP-16 in low-risk diseases.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock 72202, USA. stinekimoc@exchange.uams.edu
authors.forename: K C
authors.initials: KC
authors.lastname: Stine
authors.forename: R L
authors.initials: RL
authors.lastname: Saylors
authors.forename: J R
authors.initials: JR
authors.lastname: Sawyer
authors.forename: D L
authors.initials: DL
authors.lastname: Becton
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D015616:Histiocytosis, Non-Langerhans-Cell / Q000188:drug therapy / Q000821:virology; D006689:Hodgkin Disease / Q000188:drug therapy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced*; D008297:Male; D016609:Neoplasms, Second Primary / Q000139:chemically induced*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide