title: Acute myeloid leukemia developing in patients with autoimmune diseases.
abstract: Therapy-related acute myeloid leukemia is an unfortunate complication of cancer treatment, particularly for patients with highly curable primary malignancies and favorable life expectancy. The risk of developing therapy-related acute myeloid leukemia also applies to patients with non-malignant conditions, such as autoimmune diseases treated with cytotoxic and/or immunosuppressive agents. There is considerable evidence to suggest that there is an increased occurrence of hematologic malignancies in patients with autoimmune diseases compared to the general population, with a further increase in risk after exposure to cytotoxic therapies. Unfortunately, studies have failed to reveal a clear correlation between leukemia development and exposure to individual agents used for the treatment of autoimmune diseases. Given the dismal outcome of secondary acute myeloid leukemia and the wide range of available agents for treatment of autoimmune diseases, an increased awareness of this risk and further investigation into the pathogenetic mechanisms of acute leukemia in autoimmune disease patients are warranted. This article will review the data available on the development of acute myeloid leukemia in patients with autoimmune diseases. Possible leukemogeneic mechanisms in these patients, as well as evidence supporting the association of their primary immunosuppressive status and their exposure to specific therapies, will also be reviewed. This review also supports the idea that it may be misleading to label leukemias that develop in patients with autoimmune diseases who are exposed to cytotoxic agents as 'therapy-related leukemias'. A better understanding of the molecular defects in autoimmune disease patients who develop acute leukemia will lead to a better understanding of the association between these two diseases entities.
authors.affiliation: Department of Medical Oncology, NCI-Cairo University, 11796 Cairo, Egypt. safaanci@yahoo.com
authors.forename: Safaa M
authors.initials: SM
authors.lastname: Ramadan
authors.forename: Tamer M
authors.initials: TM
authors.lastname: Fouad
authors.forename: Valentina
authors.initials: V
authors.lastname: Summa
authors.forename: Syed Kh
authors.initials: SKh
authors.lastname: Hasan
authors.forename: Francesco
authors.initials: F
authors.lastname: Lo-Coco
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D003603:Cytotoxins / Q000008:administration & dosage / Q000009:adverse effects; D016021:Epidemiologic Studies; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D012306:Risk
chemical_list: D000970:Antineoplastic Agents; D003603:Cytotoxins; D007166:Immunosuppressive Agents