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Salvagno L, Simonato L, Sorarù M, Bianco A, Chiarion-Sileni V, Aversa SM, Camporese R, Garofolin P, Fiorentino M. Secondary Leukemia following Treatment for Hodgkin's Disease. TUMORI JOURNAL 2018; 79:103-7. [PMID: 8346559 DOI: 10.1177/030089169307900204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Patients treated for Hodgkin's disease with chemotherapy or with the association of chemotherapy and radiotherapy have an increased risk of secondary leukemia. The aim of this study was to evaluate the leukemogenic risk due to these treatment modalities. Methods We performed a case-control study on a population of 1410 patients treated for Hodgkin's disease from 1970 to 1990 in our Institute. Among these patients, we identified 25 cases of secondary leukemia and 3 cases of myelodysplasia, all occurring more than one year after the diagnosis of Hodgkin's disease. Three cases occurred among the patients treated with radiotherapy alone. When we analyzed the risk in relation to the type of treatment (radiotherapy, chemotherapy, or both), the comparisons were relative to patients treated with radiotherapy alone. Results We found that chemotherapy alone is associated with a fivefold increased risk (odds ratio = 5.4) compared with radiotherapy alone. When both treatments are used, the risk is not further increased (odds ratio = 4.4). Patients receiving more than 6 courses of chemotherapy have an excess risk (relative risk = 2.5) compared with those treated with 6 courses or less. No increased risk was observed after splenectomy. Conclusions This study confirms an increased incidence of secondary leukemia occurring in patients treated for Hodgkin's disease. The increased risk seems to be correlated with the number of courses of alkylating agent therapy, whereas it is unaffected by the addition of radiotherapy.
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Affiliation(s)
- L Salvagno
- Divisione di Oncologia Medica, Centro Oncologico Regionale, Padua, Italy
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2
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Zanini M, Zucali R, Banfi A. Bone and Soft Tissue Sarcomas in the Follow-Up of Hodgkin's Disease. TUMORI JOURNAL 2018; 69:473-6. [PMID: 6196892 DOI: 10.1177/030089168306900517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prolonged follow-up of large series of patients treated for Hodgkin's disease with an intensive therapeutic approach has demonstrated an incidence of second tumors of around 5–10%. Acute leukemia is the most frequent second neoplasia, and treatments including alkylating agents and radiotherapy seem to be correlated with a higher risk of this fatal complication. Bone and soft tissue sarcomas have rarely been observed after treatment of Hodgkin's disease, and only a few cases are described in the literature. Four cases observed at the Istituto Nazionale Tumori of Milano in a large series of nearly 800 patients treated over the last two decades with different modalities are presented. One case of chondrosarcoma and 3 cases of soft tissue sarcomas were diagnosed after a median and mean interval of 50 and 70 months, respectively (range 49–96). Three patients had been treated with radiotherapy plus chemotherapy (MOPP, 2 cases; ABVD, 1 case), and one with radiotherapy alone. The site of the second tumor was always within an irradiated area, which had received a dose ranging from 10 to 43 Gy. Prognosis of secondary bone and soft tissue sarcomas is very poor. Three of our cases died 14, 15 and 19 months after diagnosis; only one patient is alive, 3 months after diagnosis of a chondrosarcoma. The problem of second tumors in patients treated for Hodgkin's disease requires a careful evaluation of aggressive treatment modalities to minimize the risks of this severe complication.
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Sulkes A, Ruchlemer R, Neria SB, Leizerowitz R, Abeliovich D, Polliack A. Acute Monoblastic Leukemia with t(9;11) in a Patient Receiving Chemotherapy for Ovarian Cancer: Secondary Leukemia or Fortuitous Association of Two Neoplasias? Leuk Lymphoma 2016; 4:405-9. [PMID: 27467675 DOI: 10.3109/10428199109068093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe the clinical course of a 61 years old patient who developed fulminant acute monoblastic leukemia (MSA, FAB) while still on systemic chemotherapy for an advanced adenocarcinoma of the ovary. The leukemia developed following chemotherapy with Cyclophosphamide and Cisplatin (9 cycles), and then Cyclophosphamide and Carboplatin (6 cycles) resulting in a partial remission of the ovarian tumor. Survival from the onset of acute leukemia was extremely short and the cause of death was intracerebral bleeding. Cytogenetic analysis of the leukemic cells revealed a 9:11 translocation, a pattern usually occurring in de novo leukemias. The literature on the association of solid tumors, particularly ovarian cancer, with acute leukemia is reviewed; while systemic chemotherapy for ovarian cancer definitely increases the risk of secondary leukemia, especially if alkylating agents are administered, the occurrence of leukemia during the administration of chemotherapy for the solid tumor is distinctly unusual. Our patient seems to be an additional example of a recently described therapy-related variant of acute leukemia developing shortly after the onset of chemotherapy and characterized by a rapidly downhill clinical course, a monocytic lineage and a cytogenetic rearrangement t(9;11)(p22;q23). While the number of these newly described cases is still small, this additional example should increase the awareness of this potential association in Cisplatin-treated patients.
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Affiliation(s)
- A Sulkes
- a Sharett Institute of Oncology, Lymphoma-Leukemia Unit, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - R Ruchlemer
- b Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - S B Neria
- c Department of Human Genetics, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - R Leizerowitz
- b Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - D Abeliovich
- c Department of Human Genetics, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - A Polliack
- b Department of Hematology, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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4
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Allodji RS, Schwartz B, Veres C, Haddy N, Rubino C, Le Deley MC, Labbé M, Diop F, Jackson A, Dayet F, Benabdennebi A, Llanas D, Vu Bezin J, Chavaudra J, Lefkopoulos D, Deutsch E, Oberlin O, de Vathaire F, Diallo I. Risk of Subsequent Leukemia After a Solid Tumor in Childhood: Impact of Bone Marrow Radiation Therapy and Chemotherapy. Int J Radiat Oncol Biol Phys 2015; 93:658-67. [DOI: 10.1016/j.ijrobp.2015.07.2270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/22/2015] [Accepted: 07/13/2015] [Indexed: 12/21/2022]
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5
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Kamat N, Khidhir MA, Hussain S, Alashari MM, Rannug U. Chemotherapy induced microsatellite instability and loss of heterozygosity in chromosomes 2, 5, 10, and 17 in solid tumor patients. Cancer Cell Int 2014; 14:118. [PMID: 25493073 PMCID: PMC4260186 DOI: 10.1186/s12935-014-0118-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 10/27/2014] [Indexed: 01/05/2023] Open
Abstract
Background The inevitable side effects of the currently used chemotherapy are associated with serious syndromes. Genotoxic effects and consequent genetic instability may play an important role in these syndromes. The aim of the study was to evaluate chemotherapy-related microsatellite instability (MSI), loss of heterozygosity (LOH), and loss of mismatch repair (MMR) expression in solid tumor patients. Methods Samples were collected from 117 de novo patients with solid tumors of different origins. Specimens, taken pre- and post-treatment, were screened for MSI and LOH in 10 microsatellite sequences in blood, and expression of five MMR proteins were analyzed in cancer tissues using immunohistochemistry. Statistical analysis included the use of; Fisher’s exact test, Chi Square, and an inter-rater reliability test using Cohen’s kappa coefficient. Results Microsatellite analysis showed that 66.7% of the patients had MSI, including 23.1% high-positive MSI and 43.6% low-positive MSI. A large portion (41%) of the patients exhibited LOH in addition to MSI. MSI and LOH were detected in seven loci in which incidence rates ranged from 3.8% positive for Bat-26 to 34.6% positive for Tp53-Alu. Immunohistochemistry revealed that human mutL homolog 1 (hMLH1) expression was deficient in 29.1% of the patients, whereas 18.8%, 23.9%, 13.4%, and 9.7% were deficient for human mutS homolog 2 (hMSH2), P53, human mutS homolog 6 (hMSH6) and human post-meiotic segregation increased 2 (hPMS2), respectively. There was a significant correlation between MSI and LOH incidence in Tp53-Alu, Mfd41, and APC with low or deficient expression of hMLH1, hMSH2, and P53. A significant association between MSI and LOH, and incidence of secondary tumors was also evident. Conclusions The negative correlation between MMR expression, MSI, and LOH and increased resistance to anti-cancer drugs and development of secondary cancers demonstrates a useful aid in early detection of potential chemotherapy-related side-effects. The diagnostic value demonstrated in our earlier study on breast cancer patients was confirmed for other solid tumors. Electronic supplementary material The online version of this article (doi:10.1186/s12935-014-0118-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nasir Kamat
- Department of Molecular Biosciences, the Wenner-Gren Institute (MBW), Stockholm University, SE-106 91 Stockholm, Sweden
| | - Mohammed A Khidhir
- Department of Genetics Research, Management of Natural Conservations, AlAin City, UAE
| | - Sabir Hussain
- Department of Oncology and Hematology, Tawam Hospital, AlAin City, UAE
| | - Mouied M Alashari
- Department of Pathology, University of Utah, Salt Lake City, Utah 84112 USA
| | - Ulf Rannug
- Department of Molecular Biosciences, the Wenner-Gren Institute (MBW), Stockholm University, SE-106 91 Stockholm, Sweden
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6
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Rashidi A, Fisher SI. Therapy-related acute promyelocytic leukemia: a systematic review. Med Oncol 2013; 30:625. [DOI: 10.1007/s12032-013-0625-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/03/2013] [Indexed: 12/20/2022]
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7
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Shenoy P, Sinha R, Tumeh JW, Lechowicz MJ, Flowers CR. Surveillance computed tomography scans for patients with lymphoma: is the risk worth the benefits? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 10:270-7. [PMID: 20709663 DOI: 10.3816/clml.2010.n.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Concerns regarding the risks of cancer and cancer-related death as a result of radiation from computed tomography (CT) scans and the lack of data demonstrating a survival advantage for surveillance CT scans following lymphoma therapy have raised questions regarding their benefit. We compared the radiation-related lifetime cancer incidence (LCI) and mortality risks (LCMRs) associated with CT scans for staging and surveillance of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) with the cumulative probability of lymphoma death (CPLD) during surveillance. PATIENTS AND METHODS The LCI and LCMR were calculated using published estimates of the cumulative organ-specific radiation doses from full-body CT scans and sex-, age-, and organ-dependent cancer risks per 0.1 Gy provided by the Biologic Effects of Ionizing Radiations VII report. Surveillance, Epidemiology, and End Results (SEER) data were used to identify cases between 2000 and 2006 from 17 SEER registries and calculate CPLD for specified cohorts. RESULTS For a 70-year-old patient, a single full-body CT examination is associated with a LCI of 0.044% and 0.057%, and a LCMR of 0.032% and 0.044% for males and females, respectively. For 20-year-old patients the LCMRs were 0.071% for men and 0.108% for women. The LCI and LCMR were lower for males and were markedly less than the CPLD at 5 years for most lymphoma subtypes, but relevant for younger women with HL. CONCLUSION Although the LCMR from CT scans is small compared with lymphoma-related deaths for most subgroups, these data should be discussed with patients in formulating plans for surveillance following lymphoma therapy.
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Affiliation(s)
- Pareen Shenoy
- Emory University School of Medicine, Atlanta, GA, USA
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8
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Joo YH, Jung CK, Sun DI, Kim MS. Synchronous laryngeal squamous cell carcinoma and Hodgkin lymphoma of the head and neck region. Auris Nasus Larynx 2009; 36:501-4. [DOI: 10.1016/j.anl.2008.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 09/18/2008] [Accepted: 10/07/2008] [Indexed: 11/24/2022]
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9
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Akhtar N, Thompson J, Durrant ST, Angel CA, Lauder I, Wood JK. The clinical relevance of plasma viscosity in Hodgkin's disease. CLINICAL AND LABORATORY HAEMATOLOGY 2008; 13:1-8. [PMID: 2060259 DOI: 10.1111/j.1365-2257.1991.tb00245.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The erythrocyte sedimentation rate has previously been identified as an important prognostic factor in Hodgkin's disease. The plasma viscosity has replaced the ESR measurement in many laboratories, but doubts exist about its clinical relevance. In this study plasma viscosity at presentation/diagnosis was studied in 107 patients with Hodgkin's disease. A multivariate analysis of factors influencing prognosis and relapse-free survival identified plasma viscosity and number of disease sites as being highly significant. The risk of relapse increases initially with a rise in plasma viscosity, but after a value of about 2.0 mPa.s no further increase in risk is observed. When all of the prognostic factors are made available to the proportional hazards model, treatment modality and plasma viscosity are selected as the best set for predicting time to first relapse. This study demonstrates that measurement of plasma viscosity at presentation is an important prognostic factor in Hodgkin's disease, in terms of predicting outcome or risk of relapse.
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Affiliation(s)
- N Akhtar
- Department of Haematology, Leicester Royal Infirmary
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10
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Campone M, Roché H, Kerbrat P, Bonneterre J, Romestaing P, Fargeot P, Namer M, Monnier A, Montcuquet P, Goudier MJ, Fumoleau P. Secondary leukemia after epirubicin-based adjuvant chemotherapy in operable breast cancer patients: 16 years experience of the French Adjuvant Study Group. Ann Oncol 2005; 16:1343-51. [PMID: 15905306 DOI: 10.1093/annonc/mdi251] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate incidence and risk factors of secondary leukemia after adjuvant epirubicin-based chemotherapy in breast cancer patients. PATIENTS AND METHODS Among eight French Adjuvant Study Group trials, 3653 patients were assessable: 2603 received epirubicin; 682 received hormonotherapy; and 368 had no systemic treatment. Chemotherapy was FEC regimen in 85% of cases (fluorouracil 500 mg/m2, epirubicin 50, 75 or 100 mg/m2, cyclophosphamide 500 mg/m2, three or six cycles). Epirubicin cumulative dose was <300 mg/m2 in 1045 patients; 300-600 mg/m2 in 1187; and > or =600 mg/m2 in 286, followed by radiotherapy in 96% of cases. The median follow-up was 104 months. RESULTS Eight cases of leukemia occurred in epirubicin-exposed patients and one in non-exposed patients. After 9 years, the risk of developing a leukemia was 0.34% (95% confidence interval 0.11-0.57) in epirubicin-exposed patients. In patients receiving chemotherapy, leukemia subtypes were: AML2 (two), AML3 (one), AML4 (three) and ALL (two). None of the classically recognized risk factors was significantly correlated with the occurrence of a leukemia. CONCLUSION Irrespective of the dose, the incidence of secondary leukemia after adjuvant epirubicin-based chemotherapy was low. After a long follow-up, the benefit/risk ratio for early breast cancer patients remained in favor of epirubicin-based adjuvant chemotherapy: eight cases (0.31%) occurred, and in some of them, treatment causality could be debatable.
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11
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Massoud M, Armand JP, Ribrag V. Procarbazine in haematology: an old drug with a new life? Eur J Cancer 2004; 40:1924-7. [PMID: 15315798 DOI: 10.1016/j.ejca.2004.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 04/20/2004] [Accepted: 05/11/2004] [Indexed: 11/15/2022]
Abstract
Procarbazine (PCB) was developed in the 1960s and was rapidly recognised as an active agent in lymphoid malignancies. PCB was one of the four drugs combined in mechlorethamine, vincristine, PCB, prednisolone (MOPP), one of the first combination chemotherapy regimens to show that advanced-stage disease could be cured in humans. During the last few decades, comprehensive studies have clarified cellular pathways involved in the modes of action of PCB and its drug resistance mechanisms. However, late toxicities, especially secondary leukaemias and sterility, led to its withdrawal from combination regimens used to treat Hodgkin's lymphomas (HLs). PCB was recently reintroduced in dose-intensified regimens and yielded impressive results. These new regimens (bleomycin, etoposide, doxorubicin, vincristine, PCB, and prednisone (BEACOPP) or escalated BEACOPP) are now being investigated versus the classic ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) or ABVD-like combination chemotherapy regimens in the treatment of HLs.
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Affiliation(s)
- M Massoud
- Département de Médecine, Institut Gustave-Roussy, 39 Rue C Desmoulins, 94805 Villejuif, France
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12
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Abstract
Secondary leukaemias are common, accounting for more than 40% of all patients with acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS). A clinical history of exposure to haematotoxins or radiation is helpful; however, many older patients are diagnosed with leukaemia with no antecedent history of exposure. These patients' disease show a remarkably similar phenotype to classic therapy-related leukaemia. The specific cytogenetic abnormalities common to MDS, alkylating-agent-related AML and poor-prognosis AML (3q-, -5, 5q-, -7, 7q-, +8, +9, 11q-, 12p-, -18, -19,20q-, +21, t(1;7), t(2;11)), probably reflect a common pathogenesis distinct from that of other de novo AMLs, although the pathogenetic pathway has yet to be elucidated. Possibly, tumour suppressor genes are implicated and genomic instability may be a cause of multiple unbalanced chromosomal translocations or deletions. Typically, these patients are either elderly or have a history of exposure to alkylating agents or environmental exposure 5-7 years prior to diagnosis. Another distinct entity affects the mixed lineage leukaemia (MLL) gene located on 11q23. These account for about 3% of patients with therapy-related leukaemia and have a short latency period from exposure, usually to an inhibitor of topoisomerase II. Other therapy-related patients with t(8:21), inv16 or t(15;17) translocations should be treated as any other de novo AML with similar cytogenetics. In summary, the major prognostic factor is related to the pathogenetic mechanisms of the leukaemia. Cytogenetics and molecular features are a better predictor of outcome than patient history. Patients should receive standard induction therapy. However, the long-term outcome is relatively poor; the best results being obtained among patients undergoing allogeneic transplantation.
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Affiliation(s)
- E J Dann
- Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Haifa, 31096, Israel
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13
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Quina AS, Gameiro P, Sá da Costa M, Telhada M, Parreira L. PML-RARA fusion transcripts in irradiated and normal hematopoietic cells. Genes Chromosomes Cancer 2000; 29:266-75. [PMID: 10992301 DOI: 10.1002/1098-2264(2000)9999:9999<::aid-gcc1030>3.0.co;2-#] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
It is believed that two important factors in the genesis of reciprocal chromosomal translocations in malignant cells are the physical proximity of the involved regions and local structural features of the chromatin fiber that make them more susceptible to breakage and rearrangement. In this work we sought to investigate whether PML-RARA fusion transcripts, characteristic of acute promyelocytic leukemia (APL), could be induced by a clastogenic agent in cells known to have, a priori, a favorable spatial distribution of these genes. A lymphoid-cell line, lacking the t(15;17) but having the PML and RARA genes in close proximity in specific phases of the cell cycle, was irradiated with 10 Gy of (60)Co, and the incidence of PML-RARA transcripts was analyzed by a highly sensitive PCR assay. Despite gene proximity, typical PML-RARA transcripts were only rarely detected in irradiated cells. The same phenomenon was observed at similar frequency in control non-irradiated cells. These findings made us investigate whether such transcripts could also be detected in peripheral blood cells from normal individuals. PML-RARA transcripts were observed at low frequencies in isolated lymphoid and granulocytic cell populations, with similar incidence in both cell types. The data thus indicate that the PML and RARA genes are not particularly susceptible to the clastogenic effects of gamma-irradiation, and that, similar to what has been reported for other chromosomal translocations, transcriptionally active PML-RARA rearrangements can be generated in normal hematopoietic cells of different lineages without apparent oncogenic consequences.
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MESH Headings
- Chromosome Aberrations/etiology
- Chromosome Disorders
- Gamma Rays/adverse effects
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/radiation effects
- Humans
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Mutation
- Neoplasm Proteins/genetics
- Neoplasm Proteins/radiation effects
- Nuclear Proteins
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/radiation effects
- Promyelocytic Leukemia Protein
- Receptors, Retinoic Acid/genetics
- Receptors, Retinoic Acid/radiation effects
- Recombination, Genetic/radiation effects
- Retinoic Acid Receptor alpha
- Transcription Factors/genetics
- Transcription Factors/radiation effects
- Tumor Cells, Cultured/metabolism
- Tumor Cells, Cultured/radiation effects
- Tumor Suppressor Proteins
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Affiliation(s)
- A S Quina
- Institute of Histology and Embryology, Lisbon Medical School, Lisbon, Portugal
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14
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Pagano L, Pulsoni A, Mele L, Leone G. Clinical and epidemiological features of acute lymphoblastic leukemia following a previous malignancy. Leuk Lymphoma 2000; 39:465-75. [PMID: 11342330 DOI: 10.3109/10428190009113377] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Secondary malignancies represent a relevant complication of chemotherapy employed for a previous cancer. Acute leukemias represent the most frequent secondary malignancy in the first decade following primary neoplasms; secondary leukemias are generally myeloid and can be preceeded by a myelodysplastic syndrome. The biological and epidemiological characteristics of secondary acute myeloid are well known and have been the subject of numerous reports and reviews in the last few years. The observation of a secondary acute lymphoblastic leukemia is considered rare, and the correlation with antecedent therapies is not definitive. Most of reported cases are single reports, and no large study has been performed to investigate the real importance of this problem. In this review we report data of the current literature on secondary acute lymphoblastic leukemia, both in adults and children, in order to analyze its incidence and clinical and laboratory features.
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Affiliation(s)
- L Pagano
- Cattedra di Ematologia, Università Cattolica S. Cuore, Roma, Italia.
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15
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Visani G, Pagano L, Pulsoni A, Tosi P, Piccaluga PP, Pastano R, Grafone T, Malagola M, Isidori A, Tura S. Chemotherapy of secondary leukemias. Leuk Lymphoma 2000; 37:543-9. [PMID: 11042514 DOI: 10.3109/10428190009058506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chemotherapy of secondary leukemias is currently still considered to be associated with poor results. However, recent data suggest that the response to remission induction may substantially differ according to the previous medical history of the patients. Therapy related leukemia, arising following exposure to previous alkylating agents or radiotherapy, is often associated with chromosomal abnormalities involving chromosomes 5 and 7 and has a particularly bad response, whereas AML after exposure to epipodophyllotoxins or topoisomerase-II active agents could have a somewhat better response. Acute promyelocytic leukemia secondary to treatment of a primary malignant neoplasm seems to be associated with a better response if compared to other cytotypes of AML or to AML arising after transformation of myelodysplasia. However, here the literature data are not in full agreement, as different kinds of approaches have been applied. In fact, even if the problems encountered in treating patients with secondary leukemia are similar to those seen in patients with AML arising in a background of myelodysplasia (resistant disease and prolonged cytopenia after treatment), there are data suggesting that the use of high dose ara-C, with or without fludarabine, can circumvent resistance in a small but significant number of cases. One of the unsolved problems which still remains is how to consolidate the CR induced with high dose ara-C or with cycles based on anthracycline derivatives. In addition, another question relates to the categories of patients in whom chemotherapy may change the expected survival. Intensive post-remission chemotherapy, with or without autologous HSCT, may constitute an appropriate alternative for patients lacking a suitable sibling donor or for older patients who are in remission after chemotherapy and also able to tolerate other cycles of intensive chemotherapy. In this respect, the specific cytogenetic abnormality involved should be considered the most important prognostic factor for response and disease free survival; patients with abnormalities of chromosome 5 and 7 have a particularly low possibility of response and duration of CR. Furthermore, it is still debatable whether patients, especially the elderly, with these characteristics should go through a series of conventional treatments or just receive supportive treatment. On the other hand, patients with better prognostic factors should be entitled to further intensive treatments, taking into account possible delayed recovery and/or possible less successful collection of peripheral or marrow stem cells.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chromosome Aberrations
- Chromosomes, Human, Pair 5/ultrastructure
- Chromosomes, Human, Pair 7/ultrastructure
- Drug Resistance, Neoplasm
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/etiology
- Leukemia, Radiation-Induced/drug therapy
- Leukemia, Radiation-Induced/etiology
- Middle Aged
- Myelodysplastic Syndromes/drug therapy
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/therapy
- Prognosis
- Radiotherapy/adverse effects
- Salvage Therapy
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Affiliation(s)
- G Visani
- Institute of Hematology and Medical Oncology Seragnoli-University of Bologna, Italy.
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16
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Pagano L, Annino L, Ferrari A, Camera A, Martino B, Montillo M, Tosti ME, Mele A, Pulsoni A, Vegna ML, Leone G, Mandelli F. Secondary haematological neoplasm after treatment of adult acute lymphoblastic leukemia: analysis of 1170 adult ALL patients enrolled in the GIMEMA trials. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. Br J Haematol 1998; 100:669-76. [PMID: 9531332 DOI: 10.1046/j.1365-2141.1998.00616.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Between 1983 and 1994 the incidence of secondary haematological neoplasms (SHM) was evaluated in 1170 new cases of ALL enrolled in the GIMEMA trials. Of the 942 patients who achieved complete remission (CR); seven developed a SHM: four AMLs and three NHLs. The median latency from onset of ALL and of secondary haematological neoplasm was 69 months for AML and 61 months for NHL. Three out of four patients with secondary AML were unresponsive to the new chemotherapy and died, whereas the fourth patient achieved a new CR. Among the three NHL cases, two patients are presently alive in CR, whereas the third patient was refractory to chemotherapy and died. The relative risk of haematological malignancy among the GIMEMA trials population, as compared to that of the Italian Cancer Registries, was 15.25-fold higher, and the actuarial estimated cumulative proportion of ALL patients with a secondary haematological neoplasm at 5 and 10 years were 0.59% and 3.63% respectively. The incidence of adult ALL who developed a SHM, although apparently lower than in the paediatric ALL series, was higher when compared to the normal population. The difference between paediatric and adult ALL is probably due to the lack of craniospinal radiotherapy and to the lower doses of epipodoxiphyllotoxins used in adult trials. The higher percentage of childhood ALL with a prolonged event-free survival could result in an increase of secondary neoplasms in these cases, which suggests that secondary haematological neoplasms in adult ALL patients are real, although rare, events.
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Polychronopoulou S, Panagiotou JP, Papadakis T, Mavrou A, Anagnostou D, Haidas S. Secondary malignancies in a child with Hodgkin's disease: T-cell lymphoma and myelodysplastic syndrome evolving into acute nonlymphoblastic leukaemia. MEDICAL AND PEDIATRIC ONCOLOGY 1996; 26:359-66. [PMID: 8614370 DOI: 10.1002/(sici)1096-911x(199605)26:5<359::aid-mpo9>3.0.co;2-h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hodgkin's disease (HD) has been linked to an increase risk of second malignant neoplasms (SMN), especially non-Hodgkin's lymphoma (NHL) and acute nonlymphoblastic leukaemia (ANLL). The mutagenic property of cytotoxic therapy as well as defective immunity have been implicated as playing a major role in the development of SMN in patients previously treated for HD. We report a case of a 14-year-old girl with HD who developed two different second malignancies within a latent period of 28 months following HD diagnosis. The patient presented initially with bilateral cervical and supraclavicular as well as mediastinal and paraaortic lymphadenopathy. She was staged as IIIA, nodular sclerosing type HD, and was given eight alternative cycles of MOPP-ABVD followed by "mantle" field radiotherapy to a total dose of 3.3 Gy plus 0.4 Gy to the upper mediastinum. Within 8 months following the completion of therapy, a period of myelodysplasia and progressive severe immune deficiency, considered as a result of initial treatment, occurred. Eighteen months after HD diagnosis while the patient was continuously neutropenic and heavily immunocompromised, a peripheral T-cell lymphoma of the angiocentric immunoproliferative lesion type (AIL) Grade III, appeared in both lungs within and beyond the radiation field, with no evidence of HD in biopsy specimens. After institution of a new chemotherapy regimen (L17M), a satisfactory response regarding NHL lesions was noted. However, 10 months later the myelodysplastic syndrome (MDS) accompanied by complex chromosomal abnormalities evoluted to frank ANLL with a rapid fatal course. This case supports the hypothesis that combined modality treatment accompanied by severe immunodeficiency may result in the development of multiple second malignancies even within a very short latent period, especially in a subgroup of HD patients who may be particularly increased risk of second cancers.
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Affiliation(s)
- S Polychronopoulou
- Department of Paediatric Haematology/Oncology Aghia Sophia Children's Hospital, Athens, Greece
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18
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Gillis S, Sofer O, Zelig O, Dann EJ, Lotan H, Ben Yehuda D, Isacson R, Rachmilewitz EA, Ben-Bassat I, Polliack A. Acute promyelocytic leukaemia with t(15;17) following treatment of Hodgkin's disease--a report of 4 cases. Ann Oncol 1995; 6:777-9. [PMID: 8589014 DOI: 10.1093/oxfordjournals.annonc.a059315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Therapy-related acute myeloid leukemia (t-AML) is a recognized entity complicating successful therapy for Hodgkin's disease (HD) and other neoplasias after many years. This risk appears to be related to cumulative exposure to alkylating agents and procarbazine, while drugs affecting DNA--topoisomerase II, such as epipodophyllotoxins and anthracyclines, are also associated with t-AML developing after a much shorter latent period. PATIENTS AND METHODS Of 56 patients with t-AML or myelodysplasia seen in our institutes during the period 1980-1994 we encountered 5 patients with acute promyelocytic leukemia (APL) all of whom had t(15;17). Four of these had been treated for HD with both chemotherapy and radiotherapy, and one with radiotherapy alone. RESULTS To the best of our knowledge these appear to be the first cases of t-AML in HD with cytogenetically proven t(15;17). Similarly to other cases of t-APL reported after therapy for neoplasias other than HD, these patients also have a relatively favorable prognosis as seen in de-novo APL. CONCLUSIONS Although rare, t-APL should be added to the list of late complications of therapy for HD.
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Affiliation(s)
- S Gillis
- Department of Haematology, Hadassah Medical Center, Jerusalem, Israel
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19
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Meytes D, Leshno D, Berkowicz M, Modan M, Ramot B. Persistent abnormalities in red cell parameters following treatment of lymphoma. Leuk Lymphoma 1994; 15:341-5. [PMID: 7866284 DOI: 10.3109/10428199409049733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients who have recovered from malignant lymphoma are at an increased risk of secondary acute leukemia (AL), and overt AL is frequently preceded by a myelodysplastic syndrome. Although the statistical risk is significant, only a minority of the patients will be so affected. We have reviewed peripheral blood counts of patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) treated in the Departments of Hematology at the Edith Wolfson and Chaim Sheba Medical Centers, Israel. Included were only those who went into a complete remission and remained lymphoma free for extended periods. There were 85 patients with HD and 36 with NHL. In both groups peripheral blood counts at diagnosis were within the normal range. A prolonged follow-up (> 4 y), during which no further treatment was given, revealed a sustained increment over time of MCV (delta MCV) both in HD and NHL. A persistent monocytosis in HD patients was also evident. delta MCV was larger in HD. The difference at the end of the follow-up period was as follows: 10.1 fl + 11.8 in HD vs 5.0 fl + 6.2 in NHL, (P < 0.001). In addition, a significant loss of the normal correlation between the MCV and levels of hemoglobin was seen at the last follow-up. The change in MCV was present in all treatment groups, its magnitude increasing from radiotherapy to chemotherapy to combined radio chemotherapy. This trend is in analogy to the risk of secondary AL which is lower in NHL vs HD. Furthermore, it is lowest post radiotherapy and highest when both treatment modalities are used.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Meytes
- Department of Hematology, Edith Wolfson Hospital, Holon, Israel
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20
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Robinson BA, Colls BM, Fitzharris BM, Atkinson CH. Second malignant neoplasms in patients with Hodgkin's disease. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1994; 24:368-73. [PMID: 7980232 DOI: 10.1111/j.1445-5994.1994.tb01463.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM To determine the incidence of second malignant neoplasms in patients treated for Hodgkin's disease. METHODS The records were reviewed of all patients receiving primary treatment for Hodgkin's disease at the Oncology Service, Christchurch Hospital from 1969 to 1992. Second malignant neoplasms presenting at least six months after the diagnosis of Hodgkin's disease were noted and the cumulative risk estimated. RESULTS Twenty-two second malignant neoplasms developed in 20 of the 209 patients. The risk was 5.6 +/- 3.8% (CI) at five years, 11.4 +/- 6.2% at ten years, and 21.7 +/- 11.2% at 15 years and continued to increase thereafter. Thirteen patients have died of their second malignancy, including two of a third malignancy, while four have been followed for less than one year. Three leukaemias (CML, 1; acute non lymphocytic leukaemia, 2), three lymphomas and 16 solid tumours developed. The risk was greater after six or more cycles of MOPP-like chemotherapy and after radiation doses exceeding 30 Gray. The risk was less after laparotomy and splenectomy (p = 0.0205). CONCLUSIONS In view of the significant risk of a second neoplasm in survivors of Hodgkin's disease follow up should continue beyond ten years, after which time second malignancies were more likely than recurrence. Efforts should continue to minimise the carcinogenicity of therapy while preserving efficacy.
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Affiliation(s)
- B A Robinson
- Oncology Service, Christchurch Hospital, New Zealand
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21
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Thompson DS, Hainsworth JD, Hande KR, Holzmer M, Greco FA. Prolonged administration of low dose infusional etoposide in patients with advanced malignancies. A phase I/II study. Cancer 1994; 73:2824-31. [PMID: 8194024 DOI: 10.1002/1097-0142(19940601)73:11<2824::aid-cncr2820731127>3.0.co;2-t] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Etoposide displays remarkable schedule dependency. To better define the optimal dose and schedule, the authors administered etoposide as a prolonged low daily dose infusion in patients with a variety of advanced malignancies. METHODS Between October 1989 and April 1992, 40 patients met inclusion criteria and were enrolled in this study; the initial dose of infusional etoposide was 25 mg/m2/day. Doses were not escalated further, because it became evident that 25 mg/m2/day was the maximum tolerated dose (MTD) in most patients using this prolonged schedule. Because the initial dose proved to be the MTD on this prolonged schedule, several patients received a starting dose of either 20 mg/m2/day or 18 mg/m2/day. This continuous infusion was administered for at least 21 days or until either the leukocyte count dropped to less than 2,000/mm3, platelets dropped to less than 75,000/mm3, or tumor progression occurred. Plasma etoposide levels were obtained at random times during infusions at 25 mg/m2/day. RESULTS Duration of therapy ranged from 15-561 days. Myelosuppression was the major toxic reaction, although it was mild in most patients and reduced compared with other schedules. Myelosuppression correlated with the extent of prior treatment: minimally pretreated patients tolerated prolonged infusions with only mild hematologic toxic effects, whereas heavily pretreated patients experienced moderate myelosuppression. Patients treated at an initial dose of 25 mg/m2/day had more myelosuppression than did those treated at 20 mg/m2/day. A leukocyte count of less than 1,000/mm3 developed in only 5 of 40 patients (12%) at any time during therapy. Twenty-one patients required packed erythrocyte transfusions, and one required platelet transfusion. The mean serum etoposide concentration in patients receiving 25 mg/m2/day was 0.7 plus or minus 0.42 microgram/ml. Objective responses were obtained in 5 of 10 patients with previously treated non-Hodgkin's lymphoma and 2 of 3 patients with previously untreated extensive stage small cell lung cancer. CONCLUSIONS Etoposide administered by continuous infusion can be given at 25 mg/m2/day for prolonged periods to most patients and is the MTD in previously treated patients. Tumoricidal activity in selected tumor types is demonstrated with this dose. Further study in neoplasms that considered "etoposide-sensitive" seems warranted.
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Affiliation(s)
- D S Thompson
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
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22
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Bashir S, Cook P, Katz M, Mittelman A, Ahmed T. Allogeneic marrow transplantation for myelodysplastic syndrome complicating autologous bone marrow transplantation. Cancer Invest 1994; 12:484-7. [PMID: 7922704 DOI: 10.3109/07357909409021407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A patient with refractory relapsed Hodgkin's disease underwent an autologous bone marrow transplant in July 1987 and achieved remission of Hodgkin's disease. He had complete hematological recovery but developed pancytopenia 3 years post bone marrow transplantation with morphological evidence of myelodysplasia. High-dose cyclophosphamide, 200 mg/kg, chemotherapy followed by an allogeneic bone marrow transplant from a HLA-matched sibling was performed in April 1991 with complete hematological recovery. Allogeneic bone marrow transplantation was thus used successfully to treat a potential complication of autologous bone marrow transplantation.
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Affiliation(s)
- S Bashir
- Department of Medicine, New York Medical College, Valhalla 10595
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23
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Henry-Amar M, Dietrich PY. Acute Leukemia After the Treatment of Hodgkin’s Disease. Hematol Oncol Clin North Am 1993. [DOI: 10.1016/s0889-8588(18)30246-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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24
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Kantarjian HM, Estey EH, Keating MJ. Treatment of Therapy-Related Leukemia and Myelodysplastic Syndrome. Hematol Oncol Clin North Am 1993. [DOI: 10.1016/s0889-8588(18)30259-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Clinical Protocols/standards
- Decision Trees
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Myeloid, Acute/classification
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Promyelocytic, Acute/classification
- Leukemia, Promyelocytic, Acute/epidemiology
- Leukemia, Promyelocytic, Acute/therapy
- Middle Aged
- Prognosis
- Remission Induction/methods
- Survival Rate
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Affiliation(s)
- O Ballester
- H. Lee Moffitt Cancer Center and Research Institute, Department of Internal Medicine (Divisions of Hematology and Oncology), Tampa, Florida
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26
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Abstract
Thirty-seven children and adults who developed acute nonlymphocytic leukemia after the administration of chemotherapy that included etoposide or teniposide for a variety of hematologic and solid malignancies were identified. The secondary leukemia that occurred in these patients could be distinguished from the secondary leukemia that occurs after treatment with alkylating agents by the following: a shorter latency period; a predominance of monocytic or myelomonocytic features; and frequent cytogenetic abnormalities involving 11q23. Patients receiving an epipodophyllotoxin are at risk for developing secondary leukemia that has features distinct from the syndrome of secondary leukemia associated with alkylating agents.
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Affiliation(s)
- J A Whitlock
- Vanderbilt University Medical Center, Division of Pediatric Hematology-Oncology, Nashville, TN 37232
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27
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Devereux S, Selassie TG, Vaughan Hudson G, Vaughan Hudson B, Linch DC. Leukaemia complicating treatment for Hodgkin's disease: the experience of the British National Lymphoma Investigation. BMJ (CLINICAL RESEARCH ED.) 1990; 301:1077-80. [PMID: 2249071 PMCID: PMC1664202 DOI: 10.1136/bmj.301.6760.1077] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the incidence of and risk factors for the development of secondary acute leukaemia and myelodysplasia in patients treated in British National Lymphoma Investigation's studies of Hodgkin's disease since 1970. PATIENTS 2676 Patients entered into Hodgkin's disease studies between February 1970 and November 1986. Data accrued up to November 1988 were analysed, ensuring a minimum follow up period of two years. DESIGN Retrospective analysis of multicentre trial data by case-control and life table methods. RESULTS 17 Cases of secondary leukaemia were recorded in this group of 2676 patients, giving an overall risk at 15 years of 1.7%. The risks of leukaemia after chemotherapy alone and chemotherapy with radiotherapy were not significantly different. The risk of leukaemia increased sharply with the amount of treatment given as measured by the number of attempts at treatment. The 15 year risks of leukaemia were 0.2%, 2.3%, and 8.1% for patients receiving one, two, or three or more attempts at treatment. The highest risk, 22.8% at 15 years, was observed in patients treated with lomustine (CCNU), and a case-control study suggested that this was an independent risk factor. The risk of secondary leukaemia was largely related to the overall quantity of treatment, although exposure to lomustine seemed to be an important risk factor. Treatment with both drugs and radiation was not more leukaemogenic than treatment with drugs alone. The greatest risk of secondary leukaemia was seen in multiply treated patients who were unlikely to be cured of Hodgkin's disease. CONCLUSIONS Avoidance of secondary leukaemia should be a minor factor in the choice of treatment for Hodgkin's disease.
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Verhoef GE, Demuynck H, Stul MS, Cassiman JJ, Mecucci C, Van Den Berghe H, Boogaerts MA. Philadelphia chromosome-positive chronic myelogenous leukemia in treated Hodgkin's disease. CANCER GENETICS AND CYTOGENETICS 1990; 49:171-6. [PMID: 1976433 DOI: 10.1016/0165-4608(90)90139-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient who developed Philadelphia (Ph) chromosome-positive chronic myelogenous leukemia (CML) 8 years after successful treatment for Hodgkin's disease (HD) is reported. The Ph chromosome with a typical 9(22) translocation was identified by banding techniques in 80% of bone marrow (BM) cells. Southern blot analysis showed breakpoint cluster region (BCR) rearrangement as observed in classical CML. Until now, only three cases of Ph + CML have been reported after treatment for HD. At present, it is not clear whether development of CML after HD represents a therapy-induced complication, an increased susceptibility to secondary malignancies owing to the malignant process itself, a consequence of the immunological deficiencies in HD, or possibly a genetic susceptibility to malignancy.
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Affiliation(s)
- G E Verhoef
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
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29
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Abstract
The risk of any second malignancy was determined for all patients treated for a primary cancer of the breast without evidence of distant metastasis at Duke University Medical Center between 1970 and 1981. The incidence, 10-year actuarial risk (AR), and relative risk (RR) of a second malignancy developing were calculated for the 407 patients who were treated with surgery alone, 226 who were treated with surgery followed by adjuvant chemotherapy (CT), 140 who were treated with surgery plus adjuvant radiation therapy (RT), and 308 who received all three modalities (CRT). The AR of a subsequent cancer (8.4% for CRT, 8.7% for CT, 8.7% for RT, and 11.7% for surgery only patients) did not differ significantly between treatment groups. The overall second cancer RR was 1.0% after CRT (95% confidence interval [CI], 0.4 to 2.0), 1.3% after RT (95% CI, 0.6 to 2.5), 1.6% after CT (95% CI, 0.9 to 2.6), and 1.7% after surgery alone (95% CI, 1.2 to 2.4). Contralateral breast cancers (RR of 4.2%; 95% CI, 2.7 to 6.3) account for the statistically significant excess of second malignancies among the surgery alone patients. The AR for contralateral breast cancer in the surgery group was higher than in either group receiving CT (P less than 0.01), but was not significantly different from the RT group. The RR for solid tumors other than breast cancer was not significantly different from unity in any of the treatment groups. The RR for acute leukemia was 16.7% in the CRT group (95% CI, 0.2 to 92.7), 11.1% in the CT group (95% CI, 0.1 to 61.8), 10.0% in the surgery alone group (95% CI, 1.1 to 36.1), and 0.0% in the RT group (95% CI, 0.0 to 61.1). This study indicated that inclusion of RT and/or CT in the initial treatment of breast cancer did not impact negatively on patients' overall risk for a subsequent malignancy during the first decade after therapy, and that adjuvant CT with or without RT may decrease their risk of a contralateral breast cancer.
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Affiliation(s)
- R S Lavey
- Department of Radiation Oncology, University of California Los Angeles
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Abstract
The risk of a second malignancy was determined for 999 patients given primary treatment using chemotherapy only, radiation therapy only, or both for Hodgkin's Disease or a non-Hodgkin's lymphoma at Duke University Medical Center between 1970 and 1981. The incidence, 10-year actuarial risk, and relative risk of developing an acute leukemia, solid tumor, or second lymphoma were determined by treatment modality and initial lymphoma type. Among the 313 Hodgkin's disease patients, the acute leukemia actuarial risk was 2.0% after chemotherapy, 1.4% after radiation therapy, and 0.9% after combined treatment with chemotherapy and radiation therapy. Their relative risk for acute leukemia was 51.3 overall (95% confidence interval [CI] 13.8 to 131.8) and was elevated in each treatment group. Among the 686 non-Hodgkin's lymphoma patients, the acute leukemia actuarial risk was zero after radiation therapy, 4.6% after chemotherapy, and 4.5% after the combined treatment, again not significantly different between treatment groups. The leukemia relative risk was 10.6 (95% CI 3.4 to 24.8) in the chemotherapy and 11.9 (95% CI 3.2 to 30.6) in the combined treatment group. Among both the Hodgkin's disease and non-Hodgkin's lymphoma populations, the combined treatment group had a lower actuarial risk for solid tumors than either the chemotherapy or radiation therapy group (P less than 0.02). Solid tumor actuarial risk did not differ significantly between the chemotherapy and radiation therapy groups. Hodgkin's disease patients had a solid tumor relative risk that was elevated significantly after radiation therapy (6.5; 95% CI 2.4 to 14.0) and to a lesser extent after chemotherapy (2.6; 95% CI 0.8 to 6.1) or combined treatment (1.7; 95% CI 0.2 to 6.0). Solid tumor relative risk among non-Hodgkin's lymphoma patients was 0.3 for the combined treatment, 0.8 for the chemotherapy, and 1.0 for the radiation therapy group. None of the Hodgkin's disease patients developed a non-Hodgkin's lymphoma. This study found no significant difference in leukemia risk among lymphoma patients treated with chemotherapy and the combined treatment. It also found that the overall risk of a second malignancy is no higher after treatment with the combined therapy than with chemotherapy or radiation therapy alone.
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Affiliation(s)
- R S Lavey
- Department of Radiation Oncology, UCLA Center for Health Sciences 90024
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31
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Evans C, Winkelstein A, Rosenfeld CS, Zeigler ZR, Shadduck RK. High-dose cytosine arabinoside and L-asparaginase therapy for poor-risk adult acute nonlymphocytic leukemia. A retrospective study. Cancer 1990; 65:2624-30. [PMID: 2340464 DOI: 10.1002/1097-0142(19900615)65:12<2624::aid-cncr2820651204>3.0.co;2-t] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effectiveness and toxicities of high-dose cytosine arabinoside with L-asparaginase (HiDAC-ASNase) were evaluated in 41 patients with "poor risk" acute nonlymphocytic leukemia (ANLL). Twenty-four patients had either refractory or relapsed primary ANLL, and 17 had ANLL secondary to prior cytotoxic chemotherapy or an underlying hematologic disorder. The overall complete remission (CR) rate was 37%. The CR rates for primary and secondary ANLL were almost identical. Furthermore, advanced age alone did not adversely influence the CR rate. The median CR duration was 302 days with no differences between primary and secondary ANLL. The induction death rate was 24%. Predictors for induction deaths included poor initial performance status, fever at the time of presentation, low cholesterol and/or albumin, and an initial bone marrow aspirate with greater than 50% blasts. These data indicate that HiDAC-ASNase is a moderately effective regimen for patients with poor prognosis ANLL including secondary ANLL.
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Affiliation(s)
- C Evans
- University of Pittsburgh, School of Medicine, Department of Internal Medicine, Montefiore Hospital, Pennsylvania
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32
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Parker RG. Radiation-induced cancer as a factor in clinical decision making (the 1989 ASTRO Gold Medal address). Int J Radiat Oncol Biol Phys 1990; 18:993-1000. [PMID: 2189846 DOI: 10.1016/0360-3016(90)90432-j] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
1. Ionizing radiations are weak carcinogens. Under certain conditions they can induce cancers in experimental animals and humans. 2. This potential carcinogenicity has been a deterrent to the use of radiation therapy despite its many advantages in the management of patients with cancers. 3. In a range of clinical situations, such as the irradiation of cancers arising in the head and neck, breast, prostate and skin, an increase of second cancers can not be detected above the natural frequency of additional cancers. In the curative treatment of patients with Hodgkins disease, ionizing radiations are not associated with an increased frequency of leukemias and induced second tumors are no more frequent than following the use of alkylating agents. 4. All second tumors attributed to radiation therapy occur after a latent period of many years and except for leukemia usually are potentially curable. 5. The risks of radiation-induced second cancers are no greater than the risks of operative or anesthetic deaths and these catastrophes are immediate and non-remedial. 6. Therefore, at this time, the potential of radiation-induced cancers should not be a factor in the selection of treatment for patients with cancer.
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Affiliation(s)
- R G Parker
- UCLA Medical Center, Department of Radiation Oncology 90024-1714
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33
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Zarrabi MH, Rosner F. Second Neoplasms in Hodgkin’s Disease: Current Controversies. Hematol Oncol Clin North Am 1989. [DOI: 10.1016/s0889-8588(18)30558-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Hoyle CF, de Bastos M, Wheatley K, Sherrington PD, Fischer PJ, Rees JK, Gray R, Hayhoe FG. AML associated with previous cytotoxic therapy, MDS or myeloproliferative disorders: results from the MRC's 9th AML trial. Br J Haematol 1989; 72:45-53. [PMID: 2736242 DOI: 10.1111/j.1365-2141.1989.tb07650.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The outcome of treatment with standard first line therapy of 66 patients with acute myeloid leukaemia (AML) secondary to preceding chemotherapy (Group 1), a myelodysplastic state (Group 2) or a myeloproliferative disorder (Group 3) was analysed in relation to the preceding disorder, the cytogenetic pattern where available, and the cytology and cytochemistry of blood and bone marrow. The complete remission (CR) rate for the secondary AMLs was 36% (24/66), with 24% (16/66) dying in the induction period and 39% (26/66) having resistant disease. The CR rate was 25% (5/20) for Group 1, 42% (15/36) for Group 2, and 40% (4/10) for Group 3. Even after allowance for the generally older age of the secondary AML patients, they still had a significantly poorer CR rate than the de novo AMLs (P = 0.0004). The lower CR rate was chiefly due to resistant disease. Despite this, overall survival was not significantly worse for the secondary AML patients (P = 0.15). For the 36% that achieved remission, remission duration appeared similar to that of de novo cases. Of 62 cases with adequate cytology, 38 (61%) had evidence of erythroid and/or megakaryocytic dysplasia with a CR rate of 32% (12/38). The CR rate of these multineage leukaemias was not significantly different from that of the 24 (39%) who showed granulocyte/monocyte precursor involvement only, 42% (10) of whom achieved CR. The presence of features of differentiation within blast cells such as Auer rods or sudanophilia (greater than 50% positive blasts) was associated with a higher remission rate 47% (18/38) than that of poorly differentiated cases 17% (3/18) (P = 0.04) and thus appeared to be a more important determinant of CR achievement than was lineage involvement. Cases with a normal karyotype had a 33% (7/21) CR rate, while those with chromosomal abnormalities had a 37% (9/24) CR rate. Only 12 of the 45 cases with adequate cytogenetic analysis showed deletions or monosomies involving chromosomes 5 or 7, and seven of these were in Group 1.
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Affiliation(s)
- C F Hoyle
- Department of Haematological Medicine, University of Cambridge Clinical School
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35
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Abstract
A case of acute promyelocytic leukemia (APL) 3 years following the treatment of diffuse mixed non-Hodgkin's lymphoma (NHL) is presented. This is the second time APL after NHL has been reported in the literature.
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Affiliation(s)
- A Raiker
- Department of Internal Medicine, Howard University Hospital, Washington, DC 20060
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36
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Affiliation(s)
- Paul C. Vincent
- The Kanematsu LaboratoriesRoyal Prince Alfred HospitalMissenden RoadCamperdownNSW2050
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37
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Hansen NE, Karle H, Olsen JH. Trends in the incidence of multiple myeloma in Denmark 1943-1982: a study of 5500 patients. Eur J Haematol Suppl 1989; 42:72-6. [PMID: 2914596 DOI: 10.1111/j.1600-0609.1989.tb00250.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The incidence of multiple myeloma in Denmark during the period 1943-82 was examined, based on the files of the Danish National Cancer Registry. A total of 5535 patients (3023 male and 2512 female) were registered. Over the period 1943-62 the incidence increased 2- to 3-fold for both men and women, but the increase in men was steeper and was seen several years before the increase in women in all 5-yr age groups from 50 to 75 yr of age. This pattern would be compatible with an impact of environmental factors. The increase, also percentagewise, rose with increasing age. Since 1963 the incidence has been virtually stable with a possibly decreasing trend during the latest 5- to 10-yr period.
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Affiliation(s)
- N E Hansen
- Department of Medicine and Hematology, Gentofte Hospital, Hellerup, Denmark
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38
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van der Velden JW, van Putten WL, Guinee VF, Pfeiffer R, van Leeuwen FE, van der Linden EA, Vardomskaya I, Lane W, Durand M, Lagarde C. Subsequent development of acute non-lymphocytic leukemia in patients treated for Hodgkin's disease. Int J Cancer 1988; 42:252-5. [PMID: 3403068 DOI: 10.1002/ijc.2910420218] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A nested case control study was carried out to investigate the association between treatment of patients with Hodgkin's disease (HD) and the risk of developing acute non-lymphocytic leukemia (ANLL). Seven Cancer Centers of the International Cancer Patient Data Exchange System of the UICC participated. A study cohort was selected consisting of 1,681 nonpretreated patients with HD, diagnosed from 1972 through 1978, and followed up through 1984. The median follow-up time was 66 months. Eighteen cases of leukemia were observed in the cohort. The risk of development of ANLL was significantly greater for male than for female patients. The treatment characteristics associated with an increased risk of developing ANLL were extensive radiotherapy, splenectomy and the chemotherapy combination of vincristine, procarbazine and mechlorethamine.
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39
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Colman M, Easton DF, Horwich A, Peckham MJ. Second malignancies and Hodgkin's disease--the Royal Marsden Hospital experience. Radiother Oncol 1988; 11:229-38. [PMID: 3283849 DOI: 10.1016/0167-8140(88)90005-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The frequency of secondary malignant neoplasms occurring in patients treated for Hodgkin's disease at the Royal Marsden Hospital between 1963 and 1978 is reported and the literature is reviewed. 730 patients were reviewed and 583 patients permanently resident in the United Kingdom were included in the analysis. The frequency of leukaemia and solid tumors was determined from age- and sex-corrected data from the South Thames Cancer Registry. Thirty-seven malignancies were recorded in 36 patients including 9 leukaemias, 10 lung cancers, 6 skin cancers and 2 non-Hodgkin's lymphoma, all of which were observed in significant excess. When all remaining sites are combined, there was a slight excess but no one site is individually significant.
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Affiliation(s)
- M Colman
- Division of Radiation Oncology, University of California, Irvine 91717
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40
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Sonneveld P, Hagemeijer A, Abels J. Acute lymphoblastic leukaemia occurring 6 years after treatment of Hodgkin's disease. Br J Haematol 1988; 68:261-2. [PMID: 3162380 DOI: 10.1111/j.1365-2141.1988.tb06199.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- P Sonneveld
- University Hospital Rotterdam-Dijkzigt, The Netherlands
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41
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Najean Y, Deschamps A, Dresch C, Daniel MT, Rain JD, Arrago JP. Acute leukemia and myelodysplasia in polycythemia vera. A clinical study with long-term follow-up. Cancer 1988; 61:89-95. [PMID: 3334954 DOI: 10.1002/1097-0142(19880101)61:1<89::aid-cncr2820610115>3.0.co;2-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The analysis of 288 cases of polycythemia vera (PV) with a minimal follow-up of 10 years enabled us to study the characteristics of acute leukemia as observed in 33 patients (11.4%). In 50% of the patients (16 of 33), the malignant transformation is of the refractory anemia with excess of blasts (RAEB) type. Half of these further transform to acute nonlymphocytic leukemia (ANLL). Their life expectancy is not better than patients who abruptly develop ANLL. Leukemic transformation shows a frequency peak in the eighth year after initial evaluation in PV treated with chemotherapy and in the 11th year in patients treated with radiotherapy. In 30% of the patients myelofibrosis, or the spent phase of PV, is present before the transformation to acute leukemia (AL). This complication is, however, part of the natural history of PV and is observed in 20% of PV patients at 10 years when leukemic transformation is absent. Marrow fibrosis can therefore not be considered as a preleukemic phase. It was also noted that the occurrence of myeloid metaplasia/myelofibrosis is more frequent and begins earlier in patients treated by phlebotomy alone, and who do not transform to leukemia. The clinical characteristics of these AL, including high frequency of partial marrow invasion, difficulties in cytologic classification, a peak incidence similar to that in patients treated by chemotherapy or radiotherapy for a prior malignancy, multiple chromosome abnormalities, and poor response to therapy are all highly suggestive of secondary leukemias.
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Affiliation(s)
- Y Najean
- Department of Nuclear Medicine, Hôpital Saint-Louis, Paris, France
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42
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Vats TS. Hodgkin's disease. Indian J Pediatr 1987; 54:853-8. [PMID: 3326833 DOI: 10.1007/bf02761009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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43
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Decreasing risk of leukemia with prolonged follow-up after chemotherapy and radiotherapy for Hodgkin's disease. N Engl J Med 1987; 317:707-9. [PMID: 3627177 DOI: 10.1056/nejm198709103171112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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44
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Nemoto K, Ishikawa H, Ohnishi Y, Nakamura T, Ohsaki N. Hodgkin's disease accompanied with thymoma. ACTA PATHOLOGICA JAPONICA 1987; 37:1505-12. [PMID: 3687430 DOI: 10.1111/j.1440-1827.1987.tb02271.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An autopsy case of Hodgkin's disease accompanied with thymoma is reported. The patient died of acute interstitial pneumonitis 9 years after the development of lymphadenopathy. On post-mortem examination thymoma was recognized. We believe that the present case is a very rare Hodgkin's disease complicating thymoma. The occurrence of second neoplasia in Hodgkin's disease is also discussed.
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Affiliation(s)
- K Nemoto
- Second Department of Pathology, Niigata University, School of Medicine, Japan
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45
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Najean Y. The iatrogenic leukaemias induced by radio- and/or chemotherapy. MEDICAL ONCOLOGY AND TUMOR PHARMACOTHERAPY 1987; 4:245-57. [PMID: 3326987 DOI: 10.1007/bf02934521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A short review, limited to recently published series of data, has been compiled on the 'therapy-induced' secondary malignancies. Their frequency, peak of incidence, haematological and clinical criteria, the influence of age, treated primary disease, choice of drug(s) and modality of prescription and the role of genetic and environmental factors are analyzed. The risk varies between 0.6 and 20.5% after different treatment forms. Some suggestions for the choice of treatment of chronic malignant disorders, and for the design of future epidemiological studies are given.
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Affiliation(s)
- Y Najean
- Department of Nuclear Medicine and Haematology, St Louis Hospital, Paris, France
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46
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Coleman MP, Bell CM, Fraser P. Second primary malignancy after Hodgkin's disease, ovarian cancer and cancer of the testis: a population-based cohort study. Br J Cancer 1987; 56:349-55. [PMID: 3663481 PMCID: PMC2002200 DOI: 10.1038/bjc.1987.201] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The risk of second primary malignancy was assessed in a population-based cohort study of all persons registered with Hodgkin's disease (n = 2,970), ovarian cancer (n = 11,802) and testicular cancer (n = 2,013) in the South Thames Cancer Registry during the period 1961-80, to identify for further study those second malignancies which might be treatment-related. A total of 244 second malignancies was observed. After adjustment for age, sex and calendar period, the relative risk of any second malignancy was 1.4 (90% confidence interval (CI) 1.1-1.7) after Hodgkin's disease, 1.1 (90% CI 1.0-1.2) after ovarian cancer and 0.7 (90% CI 0.5-1.0) after testicular cancer. In particular, the relative risk for leukaemia was 11.9 after Hodgkin's disease, 3.7 after ovarian cancer and 2.5 after testicular cancer. Excess risks were also observed for cancers of the cervix and lung after Hodgkin's disease, for cancers of the breast, lung and rectum after ovarian cancer, and for contralateral testicular cancer. Confounding by social class or smoking does not explain these observations. The excess risks of leukaemia and of second cancer were higher in patients first diagnosed with Hodgkin's disease and ovarian cancer in the 1970s than for those first diagnosed in the 1960s. Increased use of multiple-agent chemotherapy regimes for these tumours in the 1970s may have contributed to these increases in excess risk.
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Affiliation(s)
- M P Coleman
- Imperial Cancer Research Fund, Cancer Epidemiology and Clinical Trials Unit, Radcliffe Infirmary, Oxford
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47
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Abstract
A review of the clinical data base of the Hematology/Lymphoma Service at Memorial Hospital was carried out to determine the incidence of Hodgkin's disease (HD) after treatment of non-Hodgkin's lymphoma (NHL). Five patients (four men, one woman) developed HD after treatment for NHL, with an interval ranging from 60 months to 23 years (median, 7.6 years). All but one had no evidence of NHL, when HD was diagnosed. Three patients in whom the diagnosis of HD was made soon after or concomitantly with the diagnosis of NHL also are reported. Supervening HD was more frequently of nodular sclerosis type. The patients were older (median, 63 years) than patients with HD as the first cancer (median, 32 years). The occurrence of HD after NHL has been observed so infrequently that it is unlikely that it may be related to the treatment of the first neoplasia.
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48
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Nemoto K, Honma K, Ohnishi Y, Abe M, Abe A. Three cases of secondary leukemia. Clinicopathologic findings. ACTA PATHOLOGICA JAPONICA 1987; 37:817-30. [PMID: 3477055 DOI: 10.1111/j.1440-1827.1987.tb00415.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Three cases of secondary leukemia developing after chemotherapy and/or radiotherapy for myeloma, mycosis fungoides, and non-Hodgkin's lymphoma are reported. The first case was a 51-year-old man with IgG-lambda myeloma, treated with melphalan and prednisolone, who developed acute myelomonocytic leukemia 54 months after the diagnosis of myeloma. The second case was a 54-year-old woman with mycosis fungoides treated with radiation, predonine, and cyclophosphamide, who developed acute megakaryoblastic leukemia 298 months after the diagnosis of mycosis fungoides. The third case was a 35-year-old woman with stage IV non-Hodgkin's lymphoma treated with VEMP who developed acute myelogenous leukemia 26 months after the diagnosis of malignant lymphoma. All cases showed pancytopenia and two of three cases had morphologic abnormality in several hemopoietic cell lineages in the leukemic stage. There is a possibility that second malignancies are an increasingly recognized complication in the patients treated with a large amount of chemo-radiotherapy.
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49
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Ingram L, Mott MG, Mann JR, Raafat F, Darbyshire PJ, Morris Jones PH. Second malignancies in children treated for non-Hodgkin's lymphoma and T-cell leukaemia with the UKCCSG regimens. Br J Cancer 1987; 55:463-6. [PMID: 3495284 PMCID: PMC2001694 DOI: 10.1038/bjc.1987.91] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Eight children treated between 1977 and 1983 with the UK Children's Cancer Study Group's non-Hodgkin lymphoma (NHL) and T-cell protocols have developed second malignancies within 7 years of commencing treatment. Five developed acute non-lymphoblastic leukaemia and a sixth died from infection while pancytopenic with a pre-leukaemic marrow. The other malignancies were cerebral astrocytoma and an undifferentiated low grade sarcoma. These eight children were included among 261 children studied in the first UKCCSG NHL and T-cell trials giving an actuarial incidence of 7.8% second malignancy at 7 years. Six had received adjuvant radiotherapy which may have contributed to the high incidence of second malignancy.
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50
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Brusamolino E, Papa G, Valagussa P, Mandelli F, Bernasconi C, Marmont A, Bonadonna G, Tura S, Bosi A, Mango G. Treatment-related leukemia in Hodgkin's disease: a multi-institution study on 75 cases. Hematol Oncol 1987; 5:83-98. [PMID: 2439431 DOI: 10.1002/hon.2900050203] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hematological and cytogenetic characteristics of 75 cases of therapy-related acute non lymphoid leukemia (t-ANLL) occurring in Hodgkin's disease (HD) are analysed in this multi-institution study. Combined radio and chemotherapy had been given in 88 per cent of patients, either as adjuvant (44 per cent) or as salvage modality (44 per cent). Radiotherapy alone and chemotherapy alone had been given in 3 per cent and 9 per cent respectively. Eighty per cent of patients were in remission of HD and 71 per cent off-therapy while developing leukemia. The median latent time from remission of HD to leukemia was 34 months. The myeloblastic variety of leukemia accounted for 43 per cent of total cases; the myelomonocytic and monocytic for 17 per cent and 4 per cent, the promyelocytic and erythroblastic variants for 5 per cent and 7 per cent of t-ANLL. Twenty four per cent of cases were unclassifiable; one of these was TdT-positive. Dysplastic features of erythrocytic line were invariably present with circulating erythroblasts; defects of granulocytes, circulating megathrombocytes and micromegakaryocytes were also present. Bone marrow hypoplasia and marked fibrosis were documented in 47 per cent and 30 per cent of cases. Preleukemia heralded overt leukemia in 73 per cent of cases; 37 per cent had refractory anemia with no excess of blasts; 16 per cent of preleukemias were unclassifiable. Cytogenetics revealed chromosome abnormalities in 83 per cent of cases; 72 per cent presented chromosome 5 and/or 7 monosomy or partial deletion (5q- or 7q-) of the long arm (94 per cent in the combined modality therapy group). In 3 cases, a pure monosomy 7 was observed; in none 5q-alone. Response rate to conventional therapy was 14 per cent; low and high-dose cytarabine were of little benefit. Long-term CR (28 + and 16 + months) was achieved in 2 cases with allogeneic bone marrow transplantation (BMT) as first-line therapy. A better knowledge of t-ANLL in HD and new therapies, including BMT, may improve the prognosis of this late complication of intensive HD treatment.
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