title: Therapy-related acute promyelocytic leukemia: a systematic review.
abstract: The incidence of therapy-related acute promyelocytic leukemia (t-APL) is apparently rising. We systematically reviewed the English literature until March 15, 2013, and collected a total of 326 t-APL cases, with the following results: (1) t-APL affects predominantly middle-aged adults with a median age at diagnosis of 47 years and a female-to-male ratio of 1.7:1; (2) after an incidence peak at 2 years following the completion of treatment for the primary antecedent disease, the risk of developing t-APL quickly diminishes with time; (3) the four most common primary antecedent conditions are breast cancer, hematological malignancies, multiple sclerosis, and genitourinary malignancies; (4) topoisomerase II inhibitors and radiation represent the most common potential risk factors; (5) despite different DNA damage "hot spot" sites, t-APL has no significant clinicopathologic differences from de novo APL (dn-APL); (6) t(15;17) is the sole cytogenetic abnormality in the vast majority of patients; (7) only a small minority of cases have a myelodysplastic or pancytopenic preleukemic phase; (8) more than one-third of patients come to medical attention incidentally (i.e., due to laboratory abnormalities), while the most common symptom is mucocutaneous bleeding, and 79 % have clinical DIC; and (9) the remission rate of t-APL is about 80 %, similar to dn-APL.
authors.affiliation: Department of Internal Medicine, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 410, Norfolk, VA 23507, USA. rashida@evms.edu
authors.forename: Armin
authors.initials: A
authors.lastname: Rashidi
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Fisher
mesh_terms: D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology / Q000628:therapy