title: Secondary acute leukemia following mitoxantrone-based high-dose chemotherapy for primary breast cancer patients.
abstract: The incidence of secondary myelodysplasia/acute myeloid leukemia (AML) was retrospectively assessed in an international joint study in 305 node-positive breast cancer patients, who received mitoxantrone-based high-dose chemotherapy (HDCT) followed by autologous stem cell support as adjuvant therapy. The median age of the patients was 57 years (range 22-67). In all, 268 patients received peripheral blood stem cells, and 47 patients received autologous bone marrow. After a median follow-up of 57 months (range 10-125), three cases of secondary AML (sAML) were observed, resulting in a cumulative incidence of 0.94%. One case of sAML developed 18 months after HDCT (FAB M3) The karyotype was translocation 15;17 and, after induction therapy, the patient underwent autologous stem cell transplantation, and is in complete remission (CR) of both breast cancer and AML. The second patient developed AML (FAB M4eo with inversion 16) 5 months after HDCT. This patient achieved CR after induction therapy, but died of infectious complication. A third patient developed AML (FAB M4) 6 months after HDCT. She achieved CR after induction therapy, but relapsed and expired 28 months after diagnosis of AML. sAML after mitoxantrone-based HDCT is a possible, but rare complication in breast cancer patients.
authors.affiliation: Department of Bone Marrow Transplantation, University of Hamburg, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: L
authors.initials: L
authors.lastname: Damon
authors.forename: A R
authors.initials: AR
authors.lastname: Zander
authors.forename: H
authors.initials: H
authors.lastname: Wandt
authors.forename: G
authors.initials: G
authors.lastname: Derigs
authors.forename: P
authors.initials: P
authors.lastname: Ferrante
authors.forename: T
authors.initials: T
authors.lastname: Demirer
authors.forename: G
authors.initials: G
authors.lastname: Rosti
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000628:therapy; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015994:Incidence; D007951:Leukemia, Myeloid / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D015479:Leukemia, Myelomonocytic, Acute / Q000139:chemically induced; D015473:Leukemia, Promyelocytic, Acute / Q000139:chemically induced; D007953:Leukemia, Radiation-Induced / Q000453:epidemiology / Q000209:etiology; D008207:Lymphatic Metastasis; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects*; D016609:Neoplasms, Second Primary / Q000139:chemically induced*; D017239:Paclitaxel / Q000008:administration & dosage; D036102:Peripheral Blood Stem Cell Transplantation; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D013852:Thiotepa / Q000008:administration & dosage; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D003561:Cytarabine; D015251:Epirubicin; D004317:Doxorubicin; D003520:Cyclophosphamide; D013852:Thiotepa; D008942:Mitoxantrone; D017239:Paclitaxel; D008558:Melphalan; D003630:Daunorubicin