Acute myeloid leukemia as a second malignancy: report of 9 pediatric patients in a single institution in Argentina.
BACKGROUND
Acute myeloid leukemia (AML) is well-recognized as one of the most important second malignancies. We report the occurrence of secondary AML (sAML) in our institution.


METHODS
From September 1987 to August 1996 we have observed sAML in 9 patients (median age 4 years), 5 of them previously treated for hematologic malignancies (group I): acute lymphoblastic leukemia (n = 2), AML (n = 1), non-Hodgkin lymphoma (n = 1). Hodgkin disease (n = 1), and 4 of these 9 patients treated for solid tumors (group II): neuroblastoma (n = 1), retinoblastoma (n = 1), Wilms tumor (n = 1), and central nervous system germinoma (n = 1).


RESULTS
All the patients had topoisomerase II inhibitors as part of treatment of their first malignancy, but only 5 patients received epipodophyllotoxins. Alkylating agents were part of primary therapy in 8 of 9 patients. The latency period for the development sAML was 26.5 (range = 2-55) months. The morphologic FAB features of sAML were M5 (n = 5), M4 (n = 3), and M2 (n = 1). Cytogenetic studies showed r11q23 in 3 patients, all of them with prior hematological malignancies. Initial therapy for sAML in all cases was chemotherapy (including cytarabine in combination with idarubicin and etoposide or doxorubicin or mitoxantrone). Three patients died during induction and 6 achieved complete hematologic response. Three of these patients remain disease free at +15, +51, and +99 months post-remission (including one post allogeneic BMT). The remaining 3 patients died, 1 in complete remission one month after diagnosis and 2 relapsed and died with progressive disease (one post allogeneic BMT).


CONCLUSIONS
Secondary AML is a sequela of oncologic treatments with specific cytogenetic abnormalities and poor outcome. A few patients can achieve long-term survival even with standard chemotherapy.
Felice
M S
MS
Department of Hematology-Oncology, Hospital de Pediatría SAMIC Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina.
Zubizarreta
P A
PA
Chantada
G L
GL
Alfaro
E
E
Cygler
A M
AM
Gallego
M
M
Rossi
J
J
Sackmann-Muriel
F
F
D000208:Acute Disease; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D016609:Neoplasms, Second Primary / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D012074:Remission Induction; D016896:Treatment Outcome
D000970:Antineoplastic Agents