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Gassas A, Sivaprakasam P, Cummins M, Breslin P, Patrick K, Slatter M, Skinner R, Shenton G, Gibson B, Lawson S, Petterson T, Potter M, James B, Hough R, Hiwarkar P, Vora A, Veys P, De La Fuente J, Wynn R, Amrolia P. High transplant-related mortality associated with haematopoietic stem cell transplantation for paediatric therapy-related acute myeloid leukaemia (t-AML). A study on behalf of the United Kingdom Paediatric Blood and Bone Marrow Transplant Group. Bone Marrow Transplant 2018; 53:1165-1169. [PMID: 29545594 DOI: 10.1038/s41409-018-0157-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 11/09/2022]
Abstract
Paediatric therapy-related acute myeloid leukaemia (t-AML) is rare and the outcome is poor. While allogeneic haematopoietic stem cell transplantation (HSCT) is generally the accepted modality of treatment, data regarding salvage chemotherapy, remission induction, conditioning regimens, transplant-related mortality and outcome is scarce. Between 2000 and2016, 36 children with t-AML were treated in seven UK paediatric HSCT centres. The most common salvage protocol for remission induction was FLAG with or without idarubicin and 28 patients were in complete morphological remission prior to BMT. Only 12 patients survived (33%). Transplant-related mortality (TRM) was the leading cause of death.
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Affiliation(s)
- Adam Gassas
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK.
| | - Ponni Sivaprakasam
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Michelle Cummins
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Patricia Breslin
- Department of Haematology and Oncology, Royal Hospital for Children, Bristol, UK
| | - Katharine Patrick
- Department of Haematology and Oncology, Sheffield Children's Hospital, Sheffield, UK
| | - Mary Slatter
- Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Roderick Skinner
- Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Geof Shenton
- Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Brenda Gibson
- Department of Haematology and Oncology, Royal Hospital for Children, Glasgow, UK
| | - Sarah Lawson
- Department of Haematology and Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Toni Petterson
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, UK
| | - Michael Potter
- Department of Haematology and Oncology, Royal Marsden Hospital, Sutton, UK
| | - Beki James
- Department of Haematology and Oncology, Leeds Teaching Hospital, Leeds, UK
| | - Rachael Hough
- Department of Haematology and Oncology, University College of London, London, UK
| | - Prashant Hiwarkar
- Department of Haematology and Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ajay Vora
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Veys
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
| | - Josu De La Fuente
- Department of Haematology and Oncology, St Marys Hospital, Imperial College, London, UK
| | - Robert Wynn
- Department of Haematology and Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Persis Amrolia
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children, London, UK
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Second Neoplasms in Children Following a Treatment for Acute Leukemia and/or Lymphoma: 29 Years of Experience in a Single Institution in Argentina. J Pediatr Hematol Oncol 2017; 39:e406-e412. [PMID: 28945661 DOI: 10.1097/mph.0000000000000971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Childhood acute leukemias (AL) and lymphomas achieve good survival rates. However, second neoplasms (SN) are a devastating event. METHODS From August 1987 to December 2016, 34 of 3321 (1%) patients with diagnosis of AL or lymphoma developed SN. SN were AL (n=16), CNS tumors (n=5), endocrinal tumors (n=3), lymphomas (n=2), schwannoma (n=2) assorted sarcomas (n=4), retinal melanoma (n=1), and Vanek tumor (n=1). Median latency was 51 (range, 10 to 110) months for hematological malignancies and 119 (range, 25 to 236) months for solid tumors (P=0.001). RESULTS A total of 33 patients with SN were treated taking into account cumulative doses of anthracyclines and radiotherapy. Twenty-three (67.6%) patients achieved complete remission (CR), 5 died early during therapy and 5 were refractory or partial responders. Six patients presented relapses of the SN and 1 died in CR. Seventeen patients remain alive in CR, with a median follow-up of 110 (range, 4 to 276) months. CONCLUSIONS (1) The latency period was significantly longer for patients developing solid tumors than for those developing AL. (2) AL was the most frequent SN. (3) Our results strongly encourage giving standard therapy to SN, considering cumulative doses of previous treatment, since similar probabilities of surviving as "de novo" counterparts can be achieved.
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Ruiz del Río N, Abelairas Gómez JM, Alonso García de la Rosa FJ, Peralta Calvo JM, de las Heras Martín A. [Genetic analysis results of patients with a retinoblastoma refractory to systemic chemotherapy]. ACTA ACUST UNITED AC 2015; 90:414-20. [PMID: 25817468 DOI: 10.1016/j.oftal.2015.02.011] [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] [Received: 07/02/2013] [Revised: 09/09/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the genetic alterations identified in the RB1 gene in retinoblastoma patients who do not respond to systemic chemotherapy. METHODS A genetic analysis was performed on 115 patients with retinoblastoma, 40 of whom had received systemic chemotherapy, and 29 of them had bilateral disease. Descriptive and retrospective study. Non-responders were considered as patients who are finally enucleated. RESULTS Patients with deletion type mutations are those with less preservation of the eyeball (Pearson Chi-square, P=.055). Patients with an impaired nonsense-frameshift type are more likely to preserve the eyeball. Of the 3 patients who had undergone bilateral enucleation, 2 of them had deletions and one missense alteration. Survival analysis (Kaplan-Meier curve) shows that patients with deletion type mutations are more resistance to chemotherapy, are suffering higher rates of enucleation, and for a shorter period of time (log rank [Mantel-Cox] with a significance level of P=.053), which are also associated with increased rate of being bilateral. CONCLUSIONS Patients with a genotype show increased resistance to chemotherapy should be evaluated more closely and treated with various therapeutic weapons early. Patients that have deletions in the RB1 gene are at increased risk of chemoresistance. It is likely that other genetic alterations other than RB1 gene may be related to tumor aggressiveness and treatment resistance.
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Affiliation(s)
- N Ruiz del Río
- Servicio de Oftalmología, Hospital Manises, Valencia, España.
| | - J M Abelairas Gómez
- Servicio de Oftalmología Infantil, Hospital Universitario La Paz, Madrid, España
| | | | - J M Peralta Calvo
- Servicio de Oftalmología Infantil, Hospital Universitario La Paz, Madrid, España
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Lee TC, Gombos DS, Harbour JW, Mansfield NC, Murphree AL. Retinoblastoma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weintraub M, Revel-Vilk S, Charit M, Aker M, Pe'er J, Pèer J. Secondary acute myeloid leukemia after etoposide therapy for retinoblastoma. J Pediatr Hematol Oncol 2007; 29:646-8. [PMID: 17805043 DOI: 10.1097/mph.0b013e318142b561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retinoblastoma is the most common eye tumor in children and is highly curable. Patients with hereditary retinoblastoma, have an increased risk of developing additional tumors, predominantly sarcomas. Most chemotherapy regimens used in retinoblastoma include etoposide, an epipodophyllotoxin associated with a risk of secondary myeloid leukemia. The use of etoposide in patients with a cancer predisposition syndrome such as retinoblastoma is potentially harmful, however, reports of secondary acute myeloid leukemia in patients treated with etoposide for retinoblastoma are rare. We report a case of a patient who developed secondary acute myeloid leukemia after etoposide treatment for retinoblastoma.
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Affiliation(s)
- Michael Weintraub
- Department of Pediatric Hematology-Oncology, Hadassah University Hospital, Jerusalem, Israel.
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Gombos DS, Hungerford J, Abramson DH, Kingston J, Chantada G, Dunkel IJ, Antoneli CBG, Greenwald M, Haik BG, Leal CA, Medina-Sanson A, Schefler AC, Veerakul G, Wieland R, Bornfeld N, Wilson MW, Yu CBO. Secondary acute myelogenous leukemia in patients with retinoblastoma: is chemotherapy a factor? Ophthalmology 2007; 114:1378-83. [PMID: 17613328 DOI: 10.1016/j.ophtha.2007.03.074] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 03/26/2007] [Accepted: 03/27/2007] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To describe a series of patients with secondary acute myelogenous leukemia (sAML) and retinoblastoma (RB). DESIGN Retrospective observational cases series. PARTICIPANTS Ocular and pediatric oncologists at referral centers in Europe and the Americas and the RB databases at the National Institutes of Health and the Ophthalmic Oncology Service at Memorial Sloan-Kettering Cancer Center. METHODS Physician survey, retrospective database review, and literature search. MAIN OUTCOME MEASURES History of RB and development of sAML, management of RB (surgery, radiotherapy, chemotherapy), age at diagnosis of RB and leukemia, French-American-British (FAB) subtype, and current status of patient (alive or dead). RESULTS Fifteen patients with sAML were identified; 13 occurred in childhood. Mean latent period from RB to AML diagnosis was 9.8 years (median, 42 months). Nine cases were of the M2 or M5 FAB subtypes. Twelve patients (79 %) had received chemotherapy with a topoisomerase II inhibitor, 8 (43%) had received chemotherapy with an epipodophyllotoxin. Ten children died of their leukemia. CONCLUSIONS Acute myelogenous leukemia is a rare secondary malignancy among retinoblastoma patients, many of whom were treated with primary or adjuvant chemotherapy. Additional studies are needed to assess potential risk factors contributing to sAML development in this cohort.
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Affiliation(s)
- Dan S Gombos
- Section of Ophthalmology, Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Menon BS, Juraida E, Alagaratnam J, Mohammad M, Ibrahim H, George TM, Ariffin H, Ho C, Khuzaiah R, Peng LH. Chemoreduction for intraocular retinoblastoma in Malaysia. J Pediatr Hematol Oncol 2007; 29:2-4. [PMID: 17230058 DOI: 10.1097/01.mph.0000243667.86926.c7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the last decade, chemotherapy in combination with focal therapy (chemoreduction) has been increasingly used in intraocular retinoblastoma to avoid enucleation and radiotherapy. The aim of this study was to assess the feasibility and outcome of chemoreduction in Malaysian children with retinoblastoma. This was a prospective study from August 2001 to January 2006. Twenty children (25 eyes) were given 4 cycles of chemoreduction, after which the response was assessed. Fourteen eyes showed a complete response, 10 eyes showed a partial response, and 1 eye had progressive disease. Twelve eyes developed progressive disease later, 9 after an initial complete response and 3 after a partial response. Overall, progressive disease occurred in 52%. There were 2 treatment failures, in Reese-Elsworth groups 3 and 4. Both eyes required enucleation. One eye in group 5 required second line chemotherapy to achieve a complete response. No eyes were irradiated. Five children (25%) defaulted follow-up, one of whom returned with disseminated disease. In conclusion, 4 cycles of chemoreduction achieved a durable complete response in only 12% of eyes. Chemoreduction is feasible in Malaysia but requires good patient compliance and close follow-up.
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Affiliation(s)
- Bina Sharine Menon
- Paediatric Unit, Universiti Putra Malaysia, General Hospital Kuala Lumpur, Jalan Masjid, Kuala Lumpur 50586, Malaysia.
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Murphree AL, Samuel MA, Harbour JW, Mansfield NC. Retinoblastoma. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abramson DH, Schefler AC. Transpupillary thermotherapy as initial treatment for small intraocular retinoblastoma: technique and predictors of success. Ophthalmology 2004; 111:984-91. [PMID: 15121378 DOI: 10.1016/j.ophtha.2003.08.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Accepted: 08/26/2003] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine which small retinoblastoma tumors can be treated with transpupillary thermotherapy (TTT) alone and to clarify the minimum amount of treatment required to prevent recurrence. DESIGN Noncomparative interventional case series. PARTICIPANTS Ninety-one tumors in 22 eyes of 24 patients were treated with TTT as the primary treatment modality at a single institution from 1995 until 2002. METHODS Transpupillary thermotherapy was applied only when a tumor first appeared or if growth subsequently occurred. Treatment was performed while patients were under general anesthesia with the Iris diode laser (810 nm) on continuous mode with a 1.2-mm spot size. MAIN OUTCOME MEASURES Local tumor recurrence, failure of TTT requiring the use of salvage therapies. RESULTS Mean age at diagnosis was 3 months (range, 0-19 months), and mean initial tumor base was 0.67 disc diameters (DD) (range, 0.1-1.5). Eighty-four tumors (92%) were cured with TTT alone. Seven tumors (8%) required between 1 and 5 salvage treatments: 4 tumors received cryotherapy, 3 tumors received systemic chemotherapy, 2 tumors received external beam radiation, and 1 tumor received periocular chemotherapy. All 7 tumors requiring salvage treatment were cured without enucleation. Twenty-one eyes were preserved (95%), with 1 eye enucleated secondary to growth of other tumors. The mean number of treatment sessions required for cure was 1.7 (median, 1 session, range 1-6), with 64% of the tumors requiring only 1 session. The mean power was 420 mW, the mean total duration for all sessions was 320 seconds, and the mean total energy for all treatments was 139.6 J. Univariate analysis revealed that predictors of tumor recurrence were male gender, increasing age at diagnosis, posterior and inferior tumor location, increasing initial tumor base diameter, and increasing total energy. Multivariate analysis indicated that the predictive combination of variables included male gender, increasing age at diagnosis, and increasing total energy. The predictors of need for salvage treatment on univariate analysis were male gender, inferior tumor location, increasing initial tumor base diameter, and increasing total energy. Multivariate analysis demonstrated that the most important combination of variables was male gender and increasing total energy. CONCLUSIONS Retinoblastoma tumors <1.5 DD in base diameter can be successfully treated with TTT alone. Treatment can be implemented only when recurrences occur and can be used at low power settings for a short duration.
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Affiliation(s)
- David H Abramson
- Department of Ophthalmology, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York, USA
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Imashuku S, Teramura T, Kuriyama K, Kitazawa J, Ito E, Morimoto A, Hibi S. Risk of etoposide-related acute myeloid leukemia in the treatment of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. Int J Hematol 2002; 75:174-7. [PMID: 11939264 DOI: 10.1007/bf02982023] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We studied the impact of etoposide on the prognosis of 81 patients (77 of whom were children <15 years old) with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH). The study group received a median cumulative dose of 1,500 mg/m2 etoposide (range, 0-14,550 mg/m2), with a median follow-up period of 44 months (range, 20-88 months) from the diagnosis. Only 1 patient, who received 3150 mg/m2 etoposide, developed therapy-related acute myeloid leukemia (t-AML), at 31 months after diagnosis. Excluding 9 patients who underwent hemopoietic stem cell transplantation during the course of treatment, the prognosis was poorer for those patients who received less than a 1,000 mg/m2 cumulative dose of etoposide. Our results indicate that the risk of etoposide-related t-AML is low. An appropriate dosage of etoposide for the treatment of EBV-HLH would be in the range of 1,000 to 3,000 mg/m2. However, even at these doses, care must be taken to prevent the rare risk of t-AML.
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Affiliation(s)
- Shinsaku Imashuku
- Kyoto City Institute of Health and Environmental Sciences, Kyoto, Japan
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Felice MS, Rossi J, Gallego M, Zubizarreta PA, Cygler AM, Alfaro E, Sackmann-Muriel F. Acute trilineage leukemia with monosomy of chromosome 7 following an acute promyelocytic leukemia. Leuk Lymphoma 1999; 34:409-13. [PMID: 10439380 DOI: 10.3109/10428199909050968] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe an 8 year old boy who had received chemotherapy for an acute promyelocytic leukemia and developed a secondary leukemia 27 months after the diagnosis of this first malignancy. Blasts cells were positive for cytoplasmic markers CD22, CD3 and myeloperoxidase. Cell surface T and myeloid-associated markers were also detected. Cytogenetic study disclosed monosomy 7. The patient achieved complete remission, but relapsed 15 months later with identical immunophenotypic and cytogenetic findings. Three-lineage commitment is proved by the expression of specific criteria for myeloid, and lymphoid T and B typing. A multipotent immature progenitor must be the target of leukemogenic agents. The prognosis is obviously ominous.
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MESH Headings
- Antigens, CD/analysis
- Antigens, Differentiation, B-Lymphocyte/analysis
- Biomarkers, Tumor
- CD3 Complex/analysis
- Cell Adhesion Molecules
- Child
- Chromosomes, Human, Pair 7
- Humans
- Immunophenotyping
- Karyotyping
- Lectins
- Leukemia/genetics
- Leukemia/immunology
- Leukemia/pathology
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/immunology
- Male
- Monosomy
- Peroxidase/analysis
- Recurrence
- Sialic Acid Binding Ig-like Lectin 2
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Affiliation(s)
- M S Felice
- Department of Hematology-Oncology, Hospital de Pediatria SAMIC Prof. Dr. J P Garrahan, Buenos Aires, Argentina
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Sackmann-Muriel F, Felice MS, Zubizarreta PA, Alfaro E, Gallego M, Rossi J, Cygler AM. Treatment results in childhood acute lymphoblastic leukemia with a modified ALL-BFM'90 protocol: lack of improvement in high-risk group. Leuk Res 1999; 23:331-40. [PMID: 10229318 DOI: 10.1016/s0145-2126(98)00162-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report results achieved in our institution with an acute lymphoblastic leukaemia risk-oriented treatment trial opened in January 1990 and closed on December 1995. The study was similar to the German ALL-BFM'90, except for using Protocol III for the standard-risk group, 2 g/m2 of methotrexate in Protocol M, and preventive cranial irradiation for the high-risk group only. The high-risk group included mostly patients with prednisone poor initial response and/or adverse cytogenetic features. This analysis included 374 patients, whose mean age was 6 years (range: 1 month-17 years). The overall complete remission rate was 94.4% (353/374) and the 5-year event-free survival (standard error) probability is 64(5)%. The 5-year event-free survival estimates for each risk group were: (1) high-risk group 37(5)%; (2) intermediate-risk group 66(1)%; and (3) standard-risk group 74(4)% (P = 0.0001). There are significantly higher-rates of isolated bone marrow and testicular relapses in the high-risk subset of patients. Our dismal results and the published experience, lead us to conclude that the optimal treatment for these high-risk acute lymphoblastic leukaemia patients is not currently known.
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Affiliation(s)
- F Sackmann-Muriel
- Department of Hematology and Oncology, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
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Lopes LF, de Camargo B. Secondary acute promyelocytic leukemia after treatment with etoposide for Langerhans cell histiocytosis (LCH). MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:315. [PMID: 10102032 DOI: 10.1002/(sici)1096-911x(199904)32:4<315::aid-mpo17>3.0.co;2-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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