Secondary leukemia after first-line high-dose chemotherapy for patients with advanced germ cell cancer.
OBJECTIVE
We investigated the incidence of secondary leukemia in patients treated with first-line high-dose chemotherapy (HDCT) plus autologous stem cell transplantation (PBSCT) for advanced testicular cancer.


METHODS
Three hundred and twenty-three patients who were entered into two consecutive prospective Phase-II studies of the German Testicular Cancer Study Group were analyzed. A total of 221 patients had received HD-VIP containing cisplatin, ifosfamide, and etoposide and 102 patients were treated with Tax-HD-VIP containing cisplatin, ifosfamide, etoposide, and paclitaxel, each cycle supported by autologous PBSCT.


RESULTS
Patients had received a median cumulative etoposide dose of 4.9 g/m(2) (range, 2.2-9.4 g/m(2)). The median follow-up duration for all patients was 36 months (range, 0-128) with a median follow up time of 50 months (range, 0-128) for patients surviving at least 1 year after therapy. One patient developed a secondary acute myeloid leukemia (s-AML) involving a chromosomal translocation t(11;19)(q23;p13.3) 24 months after the start of chemotherapy resulting in a cumulative incidence of 0.48% [95% confidence interval (CI) 0-1.42]. Additionally, two patients with primary mediastinal germ cell cancer developed a myelodysplastic syndrome. No solid tumors had occurred.


CONCLUSIONS
HDCT including high-dose etoposide with autologous PBSCT as first-line therapy for advanced testicular cancer was associated with an acceptably low risk of developing secondary leukemia.
Wierecky
J
J
Department of Oncology, Hematology, Immunology, and Rheumatology, Medizinische Klinik, University of Tuebingen Medical Center, Otfried-Mueller-Strasse 10, 72076 Tuebingen, Germany.
Kollmannsberger
C
C
Boehlke
I
I
Kuczyk
M
M
Schleicher
J
J
Schleucher
N
N
Metzner
B
B
Kanz
L
L
Hartmann
J T
JT
Bokemeyer
C
C
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects; D017322:Clinical Trials, Phase II as Topic; D005047:Etoposide / Q000009:adverse effects; D005500:Follow-Up Studies; D005858:Germany; D018237:Germinoma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects; D015470:Leukemia, Myeloid, Acute / Q000139:chemically induced*; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy; D015337:Multicenter Studies as Topic; D009190:Myelodysplastic Syndromes / Q000139:chemically induced; D016609:Neoplasms, Second Primary / Q000139:chemically induced*; D017239:Paclitaxel / Q000009:adverse effects; D036102:Peripheral Blood Stem Cell Transplantation; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery; D014178:Translocation, Genetic / Q000187:drug effects; D014182:Transplantation, Autologous
D005047:Etoposide; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide