title: Risk of etoposide-related acute myeloid leukemia in the treatment of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis.
abstract: We studied the impact of etoposide on the prognosis of 81 patients (77 of whom were children <15 years old) with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH). The study group received a median cumulative dose of 1,500 mg/m2 etoposide (range, 0-14,550 mg/m2), with a median follow-up period of 44 months (range, 20-88 months) from the diagnosis. Only 1 patient, who received 3150 mg/m2 etoposide, developed therapy-related acute myeloid leukemia (t-AML), at 31 months after diagnosis. Excluding 9 patients who underwent hemopoietic stem cell transplantation during the course of treatment, the prognosis was poorer for those patients who received less than a 1,000 mg/m2 cumulative dose of etoposide. Our results indicate that the risk of etoposide-related t-AML is low. An appropriate dosage of etoposide for the treatment of EBV-HLH would be in the range of 1,000 to 3,000 mg/m2. However, even at these doses, care must be taken to prevent the rare risk of t-AML.
authors.affiliation: Kyoto City Institute of Health and Environmental Sciences, Kyoto, Japan.
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Imashuku
authors.forename: Tomoko
authors.initials: T
authors.lastname: Teramura
authors.forename: Kikuko
authors.initials: K
authors.lastname: Kuriyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Kitazawa
authors.forename: Etsuro
authors.initials: E
authors.lastname: Ito
authors.forename: Akira
authors.initials: A
authors.lastname: Morimoto
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Hibi
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000633:toxicity; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000188:drug therapy; D005047:Etoposide / Q000008:administration & dosage* / Q000633:toxicity; D005260:Female; D005500:Follow-Up Studies; D015616:Histiocytosis, Non-Langerhans-Cell / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000139:chemically induced*; D008297:Male; D016609:Neoplasms, Second Primary / Q000139:chemically induced; D018570:Risk Assessment
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide