title: Secondary leukemia after chemotherapy and/or radiotherapy for gynecologic neoplasia.
abstract: OBJECTIVE
  Secondary leukemia is a known complication of chemotherapy and radiotherapy. It was generally recognized that leukemia secondary to chemotherapy was due to the use of alkylating agents in the treatment of ovarian cancer. Recently, many types of chemotherapeutic agents have been used in the treatment of gynecologic malignancies in addition to ovarian cancer. We analyzed the clinical characteristics and outcome of patients with recent onset of secondary leukemia after the treatment of gynecologic cancer to consider the diagnosis and management of secondary leukemia.
  
  
  METHODS
  We reviewed the clinical charts and follow-up data of patients with gynecologic malignancies treated in the past 20 years. During this period, 2482 newly diagnosed invasive gynecologic cancers were treated in our institution. All patients with secondary leukemia were analyzed for clinical background, latency period (interval between the diagnosis of primary carcinoma and the development of leukemia), treatment, and outcome. We also reviewed the literature for secondary leukemia under gynecology using the PubMed.
  
  
  RESULTS
  Four patients were found to have developed secondary leukemia after the treatment of gynecologic malignancies during this period. The cumulative risk of secondary leukemia was approximately 0.38%. All patients received platinum-based chemotherapy. Two patients received combination chemotherapy and/or bone marrow transplantation, and 1 of these 2 patients lived more than 6 years but died of recurrent ovarian cancer.
  
  
  CONCLUSIONS
  Long survival time might be expected in patients who show complete response to bone marrow transplantation and/or combination chemotherapy for secondary leukemia. In recent years, we have aggressively used various types of anticancer drugs for the treatment of not only ovarian cancer but also uterine cervical cancer and endometrial cancer. Physicians need to keep in mind the risk of secondary leukemia in the follow-up of long-term survivors after several courses of chemotherapy and radiotherapy.
authors.affiliation: *Gynecology Service, National Kyushu Cancer Center; and †Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Shimada
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saito
authors.forename: Masao
authors.initials: M
authors.lastname: Okadome
authors.forename: Kumi
authors.initials: K
authors.lastname: Shimamoto
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ariyoshi
authors.forename: Takako
authors.initials: T
authors.lastname: Eto
authors.forename: Yui
authors.initials: Y
authors.lastname: Tomita
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kodama
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy* / Q000532:radiotherapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D007938:Leukemia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D018906:Antineoplastic Agents, Alkylating