[Report of a case with secondary acute promyelocytic leukemia after therapy for hemophagocytic lymphohistiocytosis and review of literature].
OBJECTIVE
To explore the characteristics and risk of etoposide-related leukemia in the treatment of hemophagocytic lymphohistiocytosis (HLH).


METHODS
Clinical characteristics of a case with secondary acute promyelocytic leukemia (APL) were summarized and 10 cases of secondary leukemia after treatment for HLH from literature were analyzed.


RESULTS
The child was diagnosed with Epstein-Barr virus associated HLH and received HLH-2004 protocol. The cumulative dose of etoposide (VP16) was 3520 mg/m(2). The patient was diagnosed with APL after 28 months of HLH.He achieved complete remission after induction chemotherapy of all-trans-retinoic acid and darubicin. Consolidated chemotherapy was continued. There were 10 reports of etoposide-related leukemia after treatment for HLH in the literature.Review of 11 cases treated with VP16, of which cumulative doses were 900-20 500 mg/m(2). The interval period between HLH and secondary leukemia was 24 months. The types of secondary leukemia included 1 case with acute lymphoblastic leukemia, 1 case with myelodysplastic syndrome and 9 cases of acute myeloid leukemia. The abnormalities of chromosome included 3 patients with 11q23, 3 APL patients with t (15, 17).Seven patients survived and 4 died.


CONCLUSIONS
The latency period of etoposide-related leukemia is short. Acute myeloid leukemia and balanced chromosomal abnormality are common in etoposide-related leukemia. The risk factors for development of secondary leukemia are related to cumulative drug doses of etoposide, treatment schedules and co-administration of other antineoplastic agents.It is appropriate to keep suitable range of the cumulative dose of etoposide in HLH therapy in order to reduce the risk of therapy related leukemia.
Hematology-Oncology Center,Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Yan
Y
Su
Hematology-Oncology Center,Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Xuan
X
Zhou
Hematology-Oncology Center,Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Li
L
Zhang
Hematology-Oncology Center,Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Rui
R
Zhang
D000208:Acute Disease; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D003630:Daunorubicin / Q000008:administration & dosage; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000139:chemically induced* / Q000188:drug therapy; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D008297:Male; D016609:Neoplasms, Second Primary / Q000139:chemically induced*; D018570:Risk Assessment; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage
D000970:Antineoplastic Agents; D014212:Tretinoin; D005047:Etoposide; D003630:Daunorubicin