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Abstract
RATIONALE To investigate the clinical features of treatment-related acute granulocyte-monocytic leukemia (t-AML) from multiple myeloma (MM) thereby improving the understanding of this disease. PATIENT CONCERNS A 72-year-old woman patient was initially diagnosed as MM. Two years and 7 months after treatment, this patient developed AML M4 as confirmed by the analyses from clinical features, bone marrow morphology, flow cytometry, and cytogenetic examination. DIAGNOSIS Treatment-related acute myeloid leukaemia (t-AML). INTERVENTIONS Due to lack of the ability to pay the cost, she declined our recommendation to accept therapy as an inpatient and was discharged. LESSONS The reported case was a rare t-AML, which is resistant to currently available treatments and has a poor prognosis.
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2
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Lee HY, Ng HJ, Wong PCA, Pang SM. Therapy-related leukemia cutis after adjuvant chemotherapy in a breast cancer patient. Acta Derm Venereol 2010; 90:649-50. [PMID: 21057758 DOI: 10.2340/00015555-0911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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3
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Tasaka T, Matsuhashi Y, Uehara E, Tamura T, Kakazu N, Abe T, Nagai M. Secondary Acute Monocytic Leukemia with a Translocation t(8;16)(p11;p13): Case Report and Review of the Literature. Leuk Lymphoma 2009; 45:621-5. [PMID: 15160929 DOI: 10.1080/10428190310001593058] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute myeloblastic leukemia cases carrying the translocation t(8;16) (p11;p13) are characterized by the M4 and M5 subtypes, erythrophagocytosis by the blast cells and a poor prognosis, suggesting a new clinical entity. The t(8;16) fuses the MOZ gene which encodes a histone acetyltransferase, located on 8p11 with the CBP gene which also encodes a histone acetyltransferase, located on 16p13, and recent reports suggested that the chimeric transcription MOZ-CBP is essential for leukemogenesis. A 68-year-old woman who had been treated mainly with paclitaxel and carboplatin for preceding ovarian cancer was admitted to our hospital, complaining of right breast mass. She was diagnosed as having breast cancer and acute monocytic leukemia (M5b). Cytogenetic study with spectral karyotyping analysis revealed the development of 47 XX, + 8, t(8;16)(p11;p13). Eleven cases of therapy-related t(8;16) leukemia including the present case have been reported, but prior treatment with paclitaxel and carboplatin-based chemotherapy has never been reported. The relation of histone acetylase and therapy-related leukemia is discussed.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Carboplatin/adverse effects
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 16
- Chromosomes, Human, Pair 8
- Female
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/drug therapy
- Paclitaxel/adverse effects
- Translocation, Genetic
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Affiliation(s)
- Taizo Tasaka
- Department of Medicine, Kagawa Prefectural Central Hospital, Kagawa, Japan.
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4
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Haimi M, Motti H, Avivi I, Irit A, Moustafa N, Nivin M, Aboleil O, Olfat A, Gershoni-Baruch R, Ruth GB. Treatment-related acute myeloid leukemia characterized by t(11;20)(p15;q11) and del(9)(q22). ACTA ACUST UNITED AC 2006; 167:186-8. [PMID: 16737924 DOI: 10.1016/j.cancergencyto.2006.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
MESH Headings
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Chromosome Deletion
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 20/ultrastructure
- Chromosomes, Human, Pair 9/ultrastructure
- Female
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/diagnosis
- Leukemia, Monocytic, Acute/genetics
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/genetics
- Remission Induction
- Translocation, Genetic
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5
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Lee GY, Christina S, Tien SL, Ghafar ABA, Hwang W, Lim LC, Lim TH. Acute promyelocytic leukemia with PML-RARA fusion on i(17q) and therapy-related acute myeloid leukemia. ACTA ACUST UNITED AC 2005; 159:129-36. [PMID: 15899384 DOI: 10.1016/j.cancergencyto.2004.09.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 09/27/2004] [Accepted: 09/29/2004] [Indexed: 12/18/2022]
Abstract
We describe a patient with acute promyelocytic leukemia (APL) and the karyotype 46,XX,i(17)(q10) with PML-RARA fusion gene detected by fluorescence in situ hybridization (FISH) and nested reverse transcriptase-polymerase chain reaction (RT-PCR). FISH using dual-color translocation probes for PML (promyelocytic leukemia) and RARA (retinoic acid receptor-alpha) showed fusion signal for PML-RARA on both arms of i(17q). The patient attained complete remission (CR) with all-trans retinoic acid treatment and became PML-RARA negative. One year later, while PML-RARA negative on FISH and RT-PCR, the patient presented with thrombocytopenia. Bone marrow examination suggested an acute monoblastic leukemia (AML-M5a) including the karyotype 46,XX,t(8;16) (p11.2;p13.3),inv(11)(p15q22 approximately q23)[11]/47,idem,+i(8)(q10)[9]. She is currently in CR. The occurrence of therapy related acute leukemia after successful therapy for APL is an emerging problem.
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MESH Headings
- Antineoplastic Agents/adverse effects
- Chromosomes, Human, Pair 17
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Isochromosomes
- Karyotyping
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Promyelocytic, Acute/genetics
- Middle Aged
- Neoplasm Proteins/genetics
- Nuclear Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Promyelocytic Leukemia Protein
- Receptors, Retinoic Acid/genetics
- Retinoic Acid Receptor alpha
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription Factors/genetics
- Translocation, Genetic
- Tretinoin/adverse effects
- Tumor Suppressor Proteins
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Affiliation(s)
- Geok Yee Lee
- Cytogenetics Laboratory, Department of Pathology, Singapore General Hospital, Block 6, Level 5, Room A4, Outram Road, 169608 Singapore.
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6
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He J, Wang J, Lin L. [Clinical analysis on the bone marrow cell picture of benzene-induced acute monocytic leukemia]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2004; 22:468. [PMID: 15748491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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7
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Vizmanos JL, Larráyoz MJ, Vázquez I, Odero MD, Hernández R, Lahortiga I, Novo FJ, Ardanaz MT, Calasanz MJ. Remission of acute monocytic leukemia, secondary to treatment with epipodophyllotoxins, in a patient with t(8;16)(p11;p13) and MYST3–CREBBP fusion. ACTA ACUST UNITED AC 2004; 152:177-8. [PMID: 15262444 DOI: 10.1016/j.cancergencyto.2003.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
MESH Headings
- Adult
- Antineoplastic Agents, Phytogenic/adverse effects
- Bone Marrow Transplantation
- Chromosome Banding
- Chromosomes, Human, Pair 16/genetics
- Chromosomes, Human, Pair 8/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/therapy
- Male
- Oncogene Proteins, Fusion/genetics
- Podophyllotoxin/adverse effects
- Remission Induction
- Translocation, Genetic/genetics
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8
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Affiliation(s)
- D Jacobi
- Service de dermatologie, centre hospitalier universitaire Trousseau, 37044 cedex 01, Tours, France
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9
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Tasaka T, Nagai M, Matsuhashi Y, Uehara E, Tamura T, Ishida T, Kakazu N, Abe T. Secondary acute monocytic leukemia with a translocation t(8;22)(p11;q13). Haematologica 2002; 87:ECR19. [PMID: 12010682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
MESH Headings
- Acetyltransferases/genetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 8
- Histone Acetyltransferases
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/etiology
- Leukemia, Monocytic, Acute/genetics
- Male
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Nuclear Proteins/genetics
- Trans-Activators/genetics
- Translocation, Genetic
- Waldenstrom Macroglobulinemia/drug therapy
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Affiliation(s)
- Taizo Tasaka
- First department of Internal Medicine, Kagawa Medical University, Kyoto Prefectural University of Medicine, Kyoto, Japan
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10
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Bunworasate U, Arnouk H, Minderman H, O'Loughlin KL, Sait SN, Barcos M, Stewart CC, Baer MR. Erythropoietin-dependent transformation of myelodysplastic syndrome to acute monoblastic leukemia. Blood 2001; 98:3492-4. [PMID: 11719396 DOI: 10.1182/blood.v98.12.3492] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acute monoblastic leukemia (acute myeloid leukemia [AML], French-American-British type M5a) with leukemia cutis developed in a patient 6 weeks after the initiation of erythropoietin (EPO) therapy for refractory anemia with ringed sideroblasts. AML disappeared from both marrow and skin after the discontinuation of EPO. Multiparameter flow cytometric analysis of bone marrow cells demonstrated coexpression of the EPO receptor with CD45 and CD13 on the surface of blasts. The incubation of marrow cells with EPO, compared to without, resulted in 1.3- and 1.6-fold increases, respectively, in tritiated thymidine incorporation and bromodeoxyuridine incorporation into CD13(+) cells. Clinical and laboratory findings were consistent with the EPO-dependent transformation of myelodysplastic syndrome (MDS) to AML. It is concluded that leukemic transformation in patients with MDS treated with EPO may be EPO-dependent and that management should consist of the discontinuation of EPO followed by observation, if clinically feasible.
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Affiliation(s)
- U Bunworasate
- Department of Medicine, Leukemia Section, Clinical Cytogenetics Laboratory, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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11
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Dahéron L, Veinstein A, Brizard F, Drabkin H, Lacotte L, Guilhot F, Larsen CJ, Brizard A, Roche J. Human LPP gene is fused to MLL in a secondary acute leukemia with a t(3;11) (q28;q23). Genes Chromosomes Cancer 2001; 31:382-9. [PMID: 11433529 DOI: 10.1002/gcc.1157] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The mixed lineage leukemia, MLL, gene is frequently rearranged in patients with secondary leukemia following treatment with DNA topoisomerase II inhibitors. By FISH and Southern blot analyses we identified a rearrangement in the MLL gene due to a novel t(3;11)(q28;q23) chromosomal translocation in a patient who developed AML-M5 3 years after treatment for a follicular lymphoma. Through inverse PCR, the LPP (lipoma preferred partner) gene on 3q28 was identified as the MLL fusion partner. LPP contains substantial identity to the focal adhesion protein, zyxin, and is frequently fused to HMGIC in lipomas. The breakpoint occurred in intron 8 of MLL and LPP. Two in-frame MLL-LPP transcripts, which fuse MLL exon 8 to LPP exon 9, were detected by RT-PCR, although the smaller of these contained a deletion of 120 bp from the MLL sequence. The predicted MLL-LPP fusion protein includes the A/T hook motifs and methyltransferase domain of MLL joined to the two last LIM domains of LPP. A reciprocal LPP-MLL transcript, predicted to include the proline-rich and leucine zipper motifs, and the first LIM domain of LPP were also detected by RT-PCR. In summary, LPP is a newly identified MLL fusion partner in secondary leukemia resulting from topoisomerase inhibitors. The MLL-LPP and LPP-MLL predicted proteins contain many of the features present in other MLL rearrangements.
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MESH Headings
- Adult
- Amino Acid Sequence
- Base Sequence
- Chromosome Breakage/genetics
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 3/genetics
- Cloning, Molecular
- Cytoskeletal Proteins/genetics
- DNA-Binding Proteins/genetics
- Fatal Outcome
- Female
- Histone-Lysine N-Methyltransferase
- Humans
- Karyotyping
- LIM Domain Proteins
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/genetics
- Molecular Sequence Data
- Myeloid-Lymphoid Leukemia Protein
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Oncogene Proteins, Fusion/genetics
- Proto-Oncogenes
- RNA, Messenger/genetics
- Transcription Factors
- Translocation, Genetic/genetics
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Affiliation(s)
- L Dahéron
- Laboratoire d'Hématologie (CNRS FRE 2224), Poitiers University Hospital, CHU La Miletrie BP577, 86021 Poitiers Cedex, France
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12
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Affiliation(s)
- A Schiavetti
- Department of Pediatrics, University La Sapienza, Viale Regina Elena 324, Rome 00161, Italy
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13
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Hayakawa A, Matsuda Y, Daibata M, Nakamura H, Sano K. Genomic organization, tissue expression, and cellular localization of AF3p21, a fusion partner of MLL in therapy-related leukemia. Genes Chromosomes Cancer 2001; 30:364-74. [PMID: 11241789 DOI: 10.1002/gcc.1102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We previously identified the AF3p21 gene, a novel fusion partner of the MLL gene, in a patient who had developed therapy-related leukemia with t(3;11)(p21;q23). The AF3p21 gene encodes a protein consisting of 722 amino acids, which has an SH3 (Src homology 3) domain, a proline-rich domain, and a bipartite nuclear localization signal. The protein's SH3 domain has high homology with that of FYN. Analysis of the DNA from the patient's leukemic cells revealed that intron 6 of the MLL gene was fused at a point upstream of exon 1 in the AF3p21 gene, and that the der(11) chromosome formed an MLL-AF3p21 fusion transcript in leukemic cells, whereas the der(3) chromosome did not form any fusion transcript. The AF3p21 gene on chromosome band 3p21 is 19 kb long and consists of 13 exons. The size of the mRNA of the AF3p21 gene is approximately 3.5 kb. The AF3p21 gene is widely expressed in normal human tissues including the bone marrow, brain, liver, thymus, lung, and skeletal muscle. Western blot and immunocytochemical analyses showed that AF3p21 protein has an apparent molecular weight of 80 kDa and is localized exclusively in the cell nucleus. These results suggest the possibility that AF3p21 protein plays a role in signal transduction in the nucleus.
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MESH Headings
- Adaptor Proteins, Signal Transducing
- Adult
- Amino Acid Sequence
- Bacterial Proteins
- Base Sequence
- Cell Cycle/genetics
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 3/genetics
- Fetus
- Gene Expression Regulation, Neoplastic/genetics
- HeLa Cells
- Humans
- In Situ Hybridization, Fluorescence
- Intermediate Filament Proteins/chemistry
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/etiology
- Leukemia, Monocytic, Acute/genetics
- Lymphoma
- Molecular Sequence Data
- Molecular Weight
- Muscle Proteins
- Myeloid-Lymphoid Leukemia Protein
- Nuclear Proteins/biosynthesis
- Nuclear Proteins/chemistry
- Nuclear Proteins/genetics
- Oncogene Proteins, Fusion/biosynthesis
- Oncogene Proteins, Fusion/genetics
- Organ Specificity/genetics
- Promoter Regions, Genetic/genetics
- Stomach Neoplasms
- Translocation, Genetic/genetics
- Tumor Cells, Cultured
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Affiliation(s)
- A Hayakawa
- Department of Pediatrics, Kobe University School of Medicine, Kobe, Japan
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14
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Sano K, Hayakawa A, Piao JH, Kosaka Y, Nakamura H. Novel SH3 protein encoded by the AF3p21 gene is fused to the mixed lineage leukemia protein in a therapy-related leukemia with t(3;11) (p21;q23). Blood 2000; 95:1066-8. [PMID: 10648423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The mixed lineage leukemia (MLL) gene located at chromosome band 11q23 is frequently rearranged in patients with therapy-related acute monocytic leukemia who received topoisomerase II inhibitors. We have identified a novel fusion partner of MLL (FAB M5b) in a patient who developed t-AML 9 years after treatment for acute lymphoblastic leukemia (ALL). The leukemic cells had a sole karyotypic abnormality of t(3;11) (p21;q23). Screening of a genomic DNA library, prepared from leukemic cell DNA, identified rearranged clones composed of MLL and a novel gene on chromosome 3p21 (AF3p21). The AF3p21 gene encodes a protein of 722 amino acids, which contains an Src homology 3 (SH3) domain, a proline-rich domain, and a bipartite nuclear localizing signal (NLS). RNA analysis demonstrated that exon 6 of the MLL gene fused to exon 2 of the AF3p21 gene. The resulting chimeric protein consists of AT-hooks, methyltransferase, and transcription repressor domains of MLL in addition to the AF3p21 proline-rich domain and NLS but not the AF3p21 SH3 domain.
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MESH Headings
- Adaptor Proteins, Signal Transducing
- Adolescent
- Amino Acid Sequence
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Base Sequence
- Bone Marrow Transplantation
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- DNA, Complementary/genetics
- Daunorubicin/administration & dosage
- Daunorubicin/adverse effects
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/drug therapy
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/therapy
- Leukemia-Lymphoma, Adult T-Cell/drug therapy
- Molecular Sequence Data
- Muscle Proteins
- Myeloid-Lymphoid Leukemia Protein
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/therapy
- Nitrosourea Compounds/administration & dosage
- Nitrosourea Compounds/adverse effects
- Nuclear Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Sequence Alignment
- Sequence Homology, Nucleic Acid
- src Homology Domains/genetics
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Affiliation(s)
- K Sano
- Department of Pediatrics, Kobe University School of Medicine, Kobe, Japan.
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15
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Kollmannsberger C, Beyer J, Droz JP, Harstrick A, Hartmann JT, Biron P, Fléchon A, Schöffski P, Kuczyk M, Schmoll HJ, Kanz L, Bokemeyer C. Secondary leukemia following high cumulative doses of etoposide in patients treated for advanced germ cell tumors. J Clin Oncol 1998; 16:3386-91. [PMID: 9779717 DOI: 10.1200/jco.1998.16.10.3386] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High cumulative epipodophyllotoxin dosages are reported to be associated with an elevated risk for secondary acute myeloid leukemia (s-AML). This study examined the risk of s-AML following cumulative etoposide doses greater than 2 g/m2 in patients with metastatic germ cell tumors (GCT). PATIENTS AND METHODS The incidence of s-AML was retrospectively assessed in patients treated within clinical trials between January 1986 and February 1996 at four university centers. All patients received high-dose chemotherapy (HDCT) plus autologous stem-cell support for metastatic GCT, including high cumulative etoposide doses (> 2 g/m2). Minimum patient follow-up was 12 months. Standardized morbidity ratio (SMR) was calculated to estimate the risk associated with high cumulative etoposide doses, as compared with the general population. RESULTS A total of 302 patients with a median age of 29 years (range, 15 to 55) received a median cumulative etoposide dose of 5 g/m2 (range, 2.4 to 14 g/m2). Four cases of s-AML were observed, which resulted in a cumulative incidence of 1.3% (95% confidence interval [CI], 0.38% to 3.59%) at 52 months of median follow-up (range, 12 to 198). Two cases of secondary myelodysplasia (s-MDS) developed in patients with primary mediastinal GCT. Based on the observed four cases of AML, which are most likely etoposide-related, the risk for developing s-AML (SMR, 160 [95% CI, 43.7 to 411.2]) is significantly increased in comparison to the age-matched general population. CONCLUSION Due to the low incidence of AML in the general population, the significantly elevated risk for developing s-AML affects only 1.3% of all patients who receive etoposide doses greater than 2 g/m2. HDCT, including etoposide doses greater than 2 g/m2, is associated with an acceptably low incidence of s-AML in patients with advanced GCT.
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Affiliation(s)
- C Kollmannsberger
- Department of Hematology/Oncology, University of Tuebingen Medical Center, Germany
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16
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Orlandi E, Lazzarino M, Bernasconi P, Astori C, Bernasconi C. Secondary acute myeloid leukemia following treatment with VP16-containing regimens for non-Hodgkin's lymphoma. Haematologica 1998; 83:758-9. [PMID: 9793267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
We report on two patients who developed a secondary acute myeloid leukemia (sAL) after treatment for non-Hodgkin's lymphoma (NHL) with regimens containing low to intermediate doses of VP16. Clinical and hematologic features in these two patients were consistent with epipodophyllotoxin-associated sAL. In one case, a rearrangement of chromosome band 11q23 was detected.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Phytogenic/administration & dosage
- Antineoplastic Agents, Phytogenic/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bleomycin/administration & dosage
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Doxorubicin/administration & dosage
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/adverse effects
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Fatal Outcome
- Female
- Granulocyte Colony-Stimulating Factor/administration & dosage
- Granulocyte Colony-Stimulating Factor/adverse effects
- Humans
- Ifosfamide/administration & dosage
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Myelomonocytic, Acute/chemically induced
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, T-Cell/drug therapy
- Male
- Methotrexate/administration & dosage
- Mitoxantrone/administration & dosage
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasms, Second Primary/chemically induced
- Prednisone/administration & dosage
- Topoisomerase II Inhibitors
- Vincristine/administration & dosage
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17
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Wong O, Raabe GK. Acute myeloid and monocytic leukaemia and benzene exposure in petroleum distribution workers in the United Kingdom. Occup Environ Med 1998; 55:360-1. [PMID: 9764115 PMCID: PMC1757582 DOI: 10.1136/oem.55.5.360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Tamada T, Kimura K, Tabata M, Ishimori S, Tsuburaya T, Hayashi M. [Small cell lung cancer with acute monocytic leukemia after combined chemotherapy including etoposide]. Nihon Kyobu Shikkan Gakkai Zasshi 1997; 35:577-82. [PMID: 9234639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Small cell lung cancer (stage IIIB) developed in a 61-year-old woman. She was treated with chemotherapy in which the cumulative dose of carboplatin was 662 mg/m2 and that of etoposide was 2,000 mg/ m2, and with concurrent irradiation in which the total dose of X-rays was 44.8 Gy. The response to chemotherapy and irradiation was very good. Radiation pneumonitis developed after discharge, but it resolved after steroid therapy. Nine months after the diagnosis of lung cancer the patient was readmitted because of bleeding and leukocytosis. Acute monocytic leukemia (M5a) was diagnosed after examination of a bone-marrow aspirate. The patient was treated with chemotherapy, but she died of severe bone-marrow suppression and multiple organ failure 3 months after the diagnosis of acute monocytic leukemia. Although chromosome analysis could not be done, we strongly suspect that this leukemia was induced by etoposide, because of the clinical course.
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Affiliation(s)
- T Tamada
- Second Department of Internal Medicine, Hiraka General Hospital, Yokote, Japan
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19
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Rushton L, Romaniuk H. A case-control study to investigate the risk of leukaemia associated with exposure to benzene in petroleum marketing and distribution workers in the United Kingdom. Occup Environ Med 1997; 54:152-66. [PMID: 9155776 PMCID: PMC1128678 DOI: 10.1136/oem.54.3.152] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the risk of leukaemia in workers in the petroleum distribution industry who were exposed to low levels of benzene. METHODS From the cohort of distribution workers, 91 cases were identified as having leukaemia on either a death certificate or on cancer registration. These cases were compared with controls (four per case) randomly selected from the cohort, who were from the same company as the respective case, matched for age, and alive and under follow up at the time of case occurrence. Work histories were collected for the cases and controls, together with information about the terminals at which they had worked, fuel compositions, and occupational hygiene measurements of benzene. These data were used to derive quantitative estimates of personal exposure to benzene. Odds ratios (OR) were calculated conditional on the matching, to identify those variables in the study which were associated with risk of leukaemia. Examination of the potential effects of confounding and other variables was carried out with conditional logistic regression. Analyses were carried out for all leukaemia and separately for acute lymphoblastic, chronic lymphocytic, acute myeloid and monocytic, and chronic myeloid leukaemias. RESULTS There was no significant increase in the overall risk of all leukaemias with higher cumulative exposure to benzene or with intensity of exposure, but risk was consistently doubled in subjects employed in the industry for > 10 years. Acute lymphoblastic leukaemia tended to occur in workers employed after 1950, who started work after the age of 30, worked for a short duration, and experienced low cumulative exposure with few peaks. The ORs did not increase with increasing cumulative exposure. The risk of chronic lymphocytic leukaemia seemed to be related most closely to duration of employment and the highest risk occurred in white collar workers with long service. These workers had only background levels of benzene exposure. There was no evidence of an association of risk with any exposure variables, and no evidence of an increasing risk with increasing cumulative exposure, mean intensity, or maximum intensity of exposure. The patterns of risk for acute myeloid and monocytic leukaemia were different from those of the lymphoid subgroups, in which duration of employment was the variable most closely related to risk. Risk was increased to an OR of 2.8 (95% confidence interval (95% CI) 0.8 to 9.4) for a cumulative exposure between 4.5 and 45 ppm-years compared with < 0.45 ppm-years. For mean intensity between 0.2 and 0.4 ppm an OR of 2.8 (95% CI 0.9 to 8.5) was found compared with < 0.02 ppm. Risk did not increase with cumulative exposure, maximum intensity, or mean intensity of exposure when treated as continuous variables. Cases of acute myeloid and monocytic leukaemia were more often classified as having peaked exposures than controls, and when variables characterising peaks, particularly daily and weekly peaks, were included in the analysis these tended to dominate the other exposure variables. However, because of the small numbers it is not possible to distinguish the relative influence of peaked and unpeaked exposures on risk of acute myeloid and monocytic leukaemia. There was no evidence of an increased risk of chronic myeloid leukaemia with increases in cumulative exposure, maximum intensity, mean intensity, and duration of employment, either as continuous or categorical variables. Analyses exploring the sensitivity of the results to the source and quality of the work histories showed similar patterns in general. However, no increases in ORs for categories of cumulative exposure were found for acute myeloid and monocytic leukaemia in the data set which included work histories obtained from personnel records still in existence, although numbers were reduced. Analyses excluding the last five and 10 years of exposure showed a tendency for ORs to reduce for chronic lymphocytic leukaemia and chronic myeloid leukaemia, and to increase for acute myeloid and monocytic leukaemia. Limitations of the study include uncertainties and gaps in the information collected, and small numbers in subcategories of exposure which can lead to wide CIs around the risk estimates and poor fit of the mathematical models. CONCLUSIONS There is no evidence in this study of an association between exposure to benzene and lymphoid leukaemia, either acute or chronic. There is some suggestion of a relation between exposure to benzene and myeloid leukaemia, in particular for acute myeloid and monocytic leukaemia. Peaked exposures seemed to be experienced for this disease. However, in view of the limitations of the study, doubt remains as to whether the risk of acute myeloid and monocytic leukaemia is increased by cumulative exposures of < 45 ppm-years. Further work is recommended to review the work histories and redefine their quality, to explore the discrepancies between results for categorical and continuous variables, and to develop ranges around the expose estimates to enable further sensitivity analyses to be carried out.
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MESH Headings
- Benzene/adverse effects
- Case-Control Studies
- Cohort Studies
- Death Certificates
- Humans
- Leukemia/chemically induced
- Leukemia/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/chemically induced
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/epidemiology
- Leukemia, Myeloid/chemically induced
- Leukemia, Myeloid/epidemiology
- Logistic Models
- Male
- Occupational Diseases/chemically induced
- Occupational Diseases/epidemiology
- Occupational Exposure/adverse effects
- Occupational Exposure/analysis
- Odds Ratio
- Petroleum
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/chemically induced
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology
- Registries
- Transportation
- United Kingdom/epidemiology
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Affiliation(s)
- L Rushton
- Department of Public Health Medicine and Epidemiology, University of Nottingham, Queen's Medical Centre
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Abstract
This report updates the risk assessment by Crump and Allen for benzene-induced leukemia that was based on a cohort exposed to benzene in the manufacture of Pliofilm. The present study derives new risk estimates using data from follow-up through 1987 (whereas the earlier assessment only had follow-up available through 1978) and uses new exposure information for this cohort developed by Paustenbach et al. that accounts for a number of factors that were unknown or not fully evaluated in earlier exposure assessments. There was a significant excess of acute myelocytic or acute monocytic leukemia (AMML) (8-10 observed, 1.61 expected) in this cohort, and this end point also exhibited a strong dose-response trend. No other types of lymphatic or hematopoietic cancer were clearly linked to benzene exposure. Quantitative risk estimates were robust with respect to whether AMML or all leukemia was being modeled. They were also robust with respect whether the Paustenbach et al. or Crump and Allen exposure estimates were used (differences in risk estimates of no greater than 2-fold) as long as linear dose-response models were applied. However, whereas the Crump and Allen exposures predicted a linear dose response, the Paustenbach et al. exposures predicted a quadratic dose response. This departure from linearity was borderline significant (p = 0.08). Estimates of additional lifetime from 45 years of occupational exposure (lifetime exposure) to 1 ppm derived using he Paustenbach et al. exposure matrix and best-fitting (quadratic) models ranged from 0.020 to 0.036 per thousand, whereas corresponding estimates based on a linear dose response ranged from 1.6 to 3.1 per thousand.
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Affiliation(s)
- K S Crump
- ICF Kaiser International, Ruston, Louisiana 71270, USA.
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21
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Abstract
Biologic data on benzene metabolite doses, cytotoxicity, and genotoxicity often show that these effects do not vary directly with cumulative benzene exposure (i.e., concentration times time, or c x t). To examine the effect of an alternate exposure metric, we analyzed cell-type specific leukemia mortality in Pliofilm workers. The work history of each Pliofilm worker was used to define each worker's maximally exposed job/department combination over time and the associated long-term average concentration associated with the maximally exposed job (LTA-MEJ). Using this measure, in conjunction with four job exposure estimates, we calculated SMRs for groups of workers with increasing LTA-MEJs. The analyses suggest that a critical concentration of benzene exposure must be reached in order for the risk of leukemia or, more specifically, AMML to be expressed. The minimum concentration is between 20 and 60 ppm depending on the exposure estimate and endpoint (all leukemias or AMMLs only). We believe these analyses are a useful adjunct to previous analyses of the Pliofilm data. They suggests that (a) AMML risk is shown only above a critical concentration of benzene exposure, measured as a long-term average and experienced for years, (b) the critical concentration is between 50 and 60 ppm when using a median exposure estimate derived from three previous exposure assessments, and is between 20 and 25 ppm using the lowest exposure estimates, and (c) risks for total leukemia are driven by risks for AMML, suggesting that AMML is the cell type related to benzene exposure.
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Affiliation(s)
- A R Schnatter
- Exxon Biomedical Sciences, Inc., East Millstone, New Jersey 08875-2350, USA
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23
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Schwende H, Fitzke E, Ambs P, Dieter P. Differences in the state of differentiation of THP-1 cells induced by phorbol ester and 1,25-dihydroxyvitamin D3. J Leukoc Biol 1996; 59:555-61. [PMID: 8613704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Human THP-1 leukemia cells differentiate along the monocytic lineage following exposure to phorbol-12-myristate-13-acetate (PMA) or 1,25-dihydroxyvitamin D3 (VD3). In the monocytic cell line THP-1, PMA treatment resulted in a more differentiated phenotype than VD3, according to adherence, loss of proliferation, phagocytosis of latex beads, and expression of CD11b and CD14. Both differentiating substances induced similar effects in the release of superoxide anions (O2-). VD3-differentiated cells did not release prostaglandin E2 (PGE2), in contrast to PMA-differentiated cells, and in PMA-differentiated cells phospholipase A2 (PLA2) activity and expression was increase. Lipopolysaccharide (LPS)-stimulated tumor necrosis factor-alpha (TNF-alpha) release was higher in PMA-treated cells. PMA- but not VD3-differentiation resulted in a translocation of protein kinase C (PKC) isoenzymes to membrane fractions. Both differentiating agents up-regulated the expression of PKC isoenzymes. Whereas VD3 elevated mainly the expression of PKC-beta, PMA caused a strong increase in PKC-delta and a weak increase in PKC-alpha, PKC-epsilon, and PKC-zeta expression. These results indicate that phorbol ester and the active metabolite of vitamin D induce different signal pathways, which might result in different achievement of differentiation.
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Affiliation(s)
- H Schwende
- Biochemisches Institut, Klinik für Tumorbiologie, Freiburg, Federal Republic of Germany
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24
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Leblanc T, Hillion J, Derré J, Le Coniat M, Baruchel A, Daniel MT, Berger R. Translocation t(11;11)(q13;q23) and HRX gene rearrangement associated with therapy-related leukemia in a child previously treated with VP16. Leukemia 1994; 8:1646-8. [PMID: 7934159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A child with acute myelomonocytic leukemia, bone marrow eosinophilia and inv(16) received first-line therapy including etoposide (VP-16). Cytopenia and monocytosis appeared 7 months after complete remission while the child was treated with maintenance chemotherapy. Blood abnormalities persisted after discontinuation of treatment. Nine months after complete remission, t(11;11)(q13;q23) and HRX rearrangement were detected. Five months later, overt leukemia of monocytic type occurred. The responsibility of VP-16 therapy in this treatment-related acute myelocytic leukemia is discussed.
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MESH Headings
- Adolescent
- Blotting, Southern
- Chromosomes, Human, Pair 11
- DNA-Binding Proteins/genetics
- Etoposide/adverse effects
- Female
- Gene Rearrangement
- Histone-Lysine N-Methyltransferase
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/drug therapy
- Myeloid-Lymphoid Leukemia Protein
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Proto-Oncogenes
- Transcription Factors
- Translocation, Genetic
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Affiliation(s)
- T Leblanc
- Hématologie Pédiatrique, Hôpital Saint-Louis, Paris, France
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25
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Crump KS. Risk of benzene-induced leukemia: a sensitivity analysis of the pliofilm cohort with additional follow-up and new exposure estimates. J Toxicol Environ Health 1994; 42:219-42. [PMID: 8207757 DOI: 10.1080/15287399409531875] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This report updates the risk assessment by Crump and Allen (1984) for benzene-induced leukemia that was used by OSHA (1987) to support its reduction of the permissible exposure limit (PEL) to 1 ppm and that also was the basis for EPA's (1985) interim "unit risk" for benzene. The present study derives new risk estimates using data from follow-up through 1987 (whereas the earlier assessment only had follow-up available through 1978), and using new exposure estimates for this cohort developed by Paustenbach et al. (1992) that account for a number of factors that were unknown or not fully evaluated in earlier exposure assessments. There was a significant excess of acute myelocytic or acute monocytic leukemia (AMML, the only forms of acute nonlymphatic leukemia observed) in this cohort, and this end point also exhibited a strong dose-response trend. AMML was the only hematopoietic or lymphatic cancer that was clearly linked to benzene exposure. However, quantitative estimates of risk based on modeling either AMML or all leukemia differed by only 20%. Differences between the two Pliofilm plant locations in the occurrence of AMML were not statistically significant (.12 < or = p < or = .21) after differences in levels of benzene exposure were taken into account. The Paustenbach et al. exposures predicted a quadratic dose response, based on a measure of exposure that weighted intensity of exposure more heavily than duration of exposure. The best-fitting quadratic models predicted an additional lifetime risk of a benzene-related death from 45 yr of exposure to 1 ppm of between 0.020 and 0.036 per thousand. Statistical confidence intervals (90%) on these estimates were barely wide enough to include risk estimates based on linear dose response models. These linear models predicted risks of between 1.6 and 3.1 per thousand.
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MESH Headings
- Adult
- Aged
- Benzene/adverse effects
- Cohort Studies
- Dose-Response Relationship, Drug
- Follow-Up Studies
- Humans
- Leukemia/chemically induced
- Leukemia/epidemiology
- Leukemia/mortality
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/epidemiology
- Leukemia, Monocytic, Acute/mortality
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/mortality
- Life Tables
- Likelihood Functions
- Louisiana
- Male
- Middle Aged
- Models, Statistical
- Occupational Exposure
- Ohio
- Risk Factors
- Rubber
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Affiliation(s)
- K S Crump
- ICF Kaiser Engineers, Inc., KS Crump Group, Ruston, Louisiana 71270
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26
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Heyn R, Khan F, Ensign LG, Donaldson SS, Ruymann F, Smith MA, Vietti T, Maurer HM. Acute myeloid leukemia in patients treated for rhabdomyosarcoma with cyclophosphamide and low-dose etoposide on Intergroup Rhabdomyosarcoma Study III: an interim report. Med Pediatr Oncol 1994; 23:99-106. [PMID: 8202048 DOI: 10.1002/mpo.2950230206] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The early occurrence of five cases of acute myeloid leukemia (AML) in children treated for primary rhabdomyosarcoma on the Intergroup Rhabdomyosarcoma Study III (IRS III) has prompted this report. These patients received cyclophosphamide and four received etoposide in addition to other agents. There were 1,062 eligible patients entered on IRS III between 1984 and 1991. Following surgery, treatment consisted of multiagent chemotherapy and radiotherapy in select clinical groups. Median follow-up time is 3.7 years (range 0-7.4 years). Incidence densities and odds ratios for AML were calculated for various treatment groups. Five cases of secondary AML have been reported through August 1992. A single case of osteogenic sarcoma was reported in the same period and a patient with myelodysplastic syndrome has occurred since that time. Median time to development of AML was 39 months. Incidence density of AML for patients receiving neither cyclophosphamide nor etoposide was 0, for those receiving cyclophosphamide but no etoposide it was 7.6, and when both agents were given, it was 51.6. The odds ratios of AML for the latter two groups indicated a risk of AML which was seven times higher in the patients who received both agents. A history of breast cancer was present in all five families of patients with AML and several other cancers had occurred in three families. Preliminary analysis suggests a possible causal role for low-dose etoposide in addition to that assumed for cyclophosphamide in the early development of AML among pediatric patients treated for rhabdomyosarcoma.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Extremities
- Family Health
- Female
- Humans
- Infant
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myelomonocytic, Acute/chemically induced
- Male
- Meningeal Neoplasms/drug therapy
- Meningeal Neoplasms/radiotherapy
- Myelodysplastic Syndromes/chemically induced
- Neoplasms, Second Primary/chemically induced
- Odds Ratio
- Osteosarcoma/chemically induced
- Rhabdomyosarcoma/drug therapy
- Rhabdomyosarcoma/radiotherapy
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Risk Factors
- Spinal Neoplasms/drug therapy
- Spinal Neoplasms/radiotherapy
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Affiliation(s)
- R Heyn
- Mott Children's Hospital, Ann Arbor, MI 48109-0238
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27
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Smith MA, Rubinstein L, Ungerleider RS. Therapy-related acute myeloid leukemia following treatment with epipodophyllotoxins: estimating the risks. Med Pediatr Oncol 1994; 23:86-98. [PMID: 8202047 DOI: 10.1002/mpo.2950230205] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the past decade, therapy-related acute myeloid leukemia (t-AML) following treatment with regimens that include inhibitors of topoisomerase-II (TOPO-II) has been reported with increasing frequency. These cases of t-AML generally have a shorter latency period than t-AML following alkylator therapy, are associated with chromosomal translocations (especially involving chromosome band 11q23), and usually present as M4 or M5 FAB subtype. Although the epipodophyllotoxins (etoposide and teniposide) have been most often implicated, similar cases of t-AML occur following therapy with other classes of Topo-II inhibitors (e.g., anthracyclines). There is wide variation in published studies in the estimates of risk of t-AML following epipodophyllotoxin therapy. These varying estimates may reflect a number of factors, including: small sample size leading to large confidence intervals around risk estimates; varying susceptibility of different patient populations; varying schedules of epipodophyllotoxin administration; different cumulative doses of epipodophyllotoxins; and administration of epopodophyllotoxins with additional agents that may alter the leukemogenic effect of the epipodophyllotoxins. Available data suggest that children with acute lymphocytic leukemia (ALL) treated with high cumulative doses of epipodophyllotoxins using either weekly or twice-weekly schedules of administration have a relatively high risk of developing t-AML (5-12% cumulative risk). On the other hand, germ cell patients treated with relatively low cumulative doses of etoposide (usually 1,500-2,500 mg/m2) appear to have a low risk for developing t-AML. There is inadequate experience at this time with higher cumulative doses of etoposide (e.g., 4,000-5,000 mg/m2 as used for pediatric solid tumors) given on a daily x 5 schedule to allow estimates of risk to be developed for this schedule and cumulative dose. The Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute (NCI) has developed a monitoring plan designed to obtain reliable estimates of the risk of t-AML following epipodophyllotoxin treatment. Twelve Cooperative Group clinical trials that use epipodophyllotoxins at either low (< 1,500 mg/m2), moderate (1,500-3,999 mg/m2), or higher cumulative doses (> 4,000 mg/m2) are being prospectively monitored for cases of t-AML occurring among patients entered onto the trials.
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MESH Headings
- Alkylating Agents/adverse effects
- Cell Cycle/drug effects
- Child
- Chromosomes, Human, Pair 11
- Clinical Trials as Topic
- Drug Administration Schedule
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myelomonocytic, Acute/chemically induced
- Lymphoma, Non-Hodgkin/drug therapy
- Neoplasms, Second Primary/chemically induced
- Podophyllotoxin/adverse effects
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Prospective Studies
- Risk Factors
- Topoisomerase II Inhibitors
- Translocation, Genetic
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Affiliation(s)
- M A Smith
- Cancer Therapy Evaluation Program, DCT, NCI, Bethesda, Maryland 20892
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28
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Segelov E, Raghavan D, Coates A, Kronenberg H. Acute leukaemia following chemotherapy including etoposide for testicular carcinoma. Aust N Z J Med 1993; 23:718-9. [PMID: 8141707 DOI: 10.1111/j.1445-5994.1993.tb04741.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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29
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Zhang MH, Wang XY, Gao LS. [140 cases of acute leukemia caused by bimolane]. Zhonghua Nei Ke Za Zhi 1993; 32:668-72. [PMID: 8156836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The cooperative group included 18 provincial and district hospitals. A retrospective study was carried out on 140 cases of therapy related leukemia (TRL) caused by bimolane (BML) for psoriasis from 1984 to 1992. This series of BML-TRL consists of 90 male and 50 female patients. 87.1% of them were from 20 to 50 years old. Annual incidence varied from 4 to 24 cases, and was maintained at this level through the period from 1986 to 1991 without any declining tendency. The average time interval between BML administration and diagnosis of leukemia was 46 months. 138 cases were diagnosed as ANLL and 2 cases were suspected of having ALL. Subtype frequency was shown as follows: M3 > M2 > M5 > M4 > M1 > M6. 67.1% of the patients had a low peripheral white blood cell counts (< 5 x 10(9)/L). 116 patients received chemotherapy. A 26.7% remission rate was obtained with 18.1% complete remission and 8.6% partial remission. A 115 day median survival was calculated through a follow up survey of 95 patients. Finally, we concluded that: (1) This has been the largest group of non-cancer-therapy-related-leukemia patients ever reported. This type of leukemia is characterized by a shorter latent period, higher remission rate less incidence of myelodysplastic syndrome and more frequent occurrence of leukopenia, as compared with other types of TRL. BML is supposed to be a strong leukemia-causing cytotoxic agent. Use of this drug in psoriasis and other benign diseases is not recommended.
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Affiliation(s)
- M H Zhang
- Shandong Cooperative Group on Therapy-Related Leukemia, Affiliated Hospital, Shandong Medical University, Jinan
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30
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McGee JH, Butler WH, Willigan DA, Brown WR, Sofia RD. Critique of the toxicology and carcinogenesis studies of iodinated glycerol in F344/N rats and B6C3F1 mice. Regul Toxicol Pharmacol 1993; 18:169-80. [PMID: 8278639 DOI: 10.1006/rtph.1993.1051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Carter-Wallace conducted a detailed audit and evaluation of the data available from the carcinogenicity studies with iodinated glycerol conducted in the B6C3F1 mouse and the F344/N rat by the National Toxicology Program (NTP). We conclude that there is no evidence of carcinogenicity of the compound in either the B6C3F1 mouse or the F344/N rat.
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Affiliation(s)
- J H McGee
- Wallace Laboratories, Division of Carter-Wallace Inc., Cranbury, New Jersey 08512
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31
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Felix CA, Winick NJ, Negrini M, Bowman WP, Croce CM, Lange BJ. Common region of ALL-1 gene disrupted in epipodophyllotoxin-related secondary acute myeloid leukemia. Cancer Res 1993; 53:2954-6. [PMID: 8319201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Translocations at chromosomal band 11q23 characterize most de novo acute lymphoblastic leukemias (ALL) of infants, acute myeloid leukemias (AML) of infants and young children, and secondary AMLs following epipodophyllotoxin exposure. The chromosomal breakpoints at 11q23 have been cloned from isolated cases of de novo ALL and AML. Using an 859-base pair BamHI fragment of human ALL-1 complementary DNA that recognizes the genomic breakpoint region for de novo ALL and AML, we investigated two cases of secondary AML that followed etoposide-treated primary B-lineage ALL. In the first case, the translocation occurred between chromosomes 9 and 11 and the breakpoint at 11q23 localized to the same 9-kilobase region of the ALL-1 gene that is disrupted in most of the de novo leukemias. In the second case the translocation was between chromosomes 11 and 19. The breakpoint occurred outside of the ALL-1 breakpoint cluster region.
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MESH Headings
- Child, Preschool
- Chromosomes, Human, Pair 11/drug effects
- Chromosomes, Human, Pair 11/physiology
- DNA, Neoplasm/genetics
- DNA, Neoplasm/metabolism
- DNA-Cytosine Methylases/metabolism
- Etoposide/adverse effects
- Etoposide/therapeutic use
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Male
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Podophyllotoxin/adverse effects
- Podophyllotoxin/therapeutic use
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Translocation, Genetic/drug effects
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Affiliation(s)
- C A Felix
- Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania 19104
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32
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Marth C, Pointner E, Zeimet AG, Abfalter E, Koza A, Windbichler G, Hetzel H, Dapunt O. [The value of etoposide (VP-16) in the therapy of refractory ovarian cancer]. Geburtshilfe Frauenheilkd 1993; 53:303-7. [PMID: 8514100 DOI: 10.1055/s-2007-1022887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
In analogy to Kühnle et al. (1984) the role of etoposide in patients with cisplatin-refractory ovarian cancer was evaluated. 45 patients were treated with 150-200 mg of etoposide per sa. m. on days 1-3. Acute toxicity was tolerable except alopecia grade III. Remarkable, however, was the induction of two fatal cases of leukaemia following etoposide treatment. The first patient, who was 27 years old, with FIGO stage IIb serous cystadenocarcinoma, which was treated with cisplatin/epirubicin and after a latent period of 45 months, a local recurrence was treated with 8 cycles of etoposide. Twenty-three months after discontinuation of etoposide therapy, the patient showed acute myelogenous leukaemia (AML) of M5b-subtype according to the FAB classification. Two days after diagnosis, the patient died of the disease. The second patient, a 55-year old woman with FIGO stage IIa serous cystadenocarcinoma, was treated with cisplatin/cytoxan; 8 cycles of etoposide were given as a second line therapy. This patient, 21 months after discontinuation of etoposide therapy showed a pre-pre-B-acute lymphocytic leukaemia with coexpression of the myeloid antigens. Two months after diagnosis, the patient died of the disease. In 4 out of 38 patients, a complete and in 7 patients a partial remission was induced by etoposide treatment and survival of these responding patients was prolonged in comparison with the nonresponder. The survival was also dependent on CA-125 serum level and the cumulative dose of etoposide administered. Etoposide treatment is an acceptable option as salvage therapy in refractory ovarian cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Marth
- Universitätsklinik für Frauenheilkunde Innsbruck
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33
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Keung YK, Liang R, Chiu EK. Acute leukemia associated with mediastinal germ cell tumor. De novo versus therapy-related leukemia. West J Med 1993; 158:409-12. [PMID: 8391189 PMCID: PMC1022078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
MESH Headings
- Adult
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Chromosomes, Human, Pair 8
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/etiology
- Leukemia, Monocytic, Acute/genetics
- Male
- Mediastinal Neoplasms/chemically induced
- Mediastinal Neoplasms/etiology
- Mediastinal Neoplasms/genetics
- Neoplasms, Germ Cell and Embryonal/complications
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Second Primary
- Time Factors
- Trisomy
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Affiliation(s)
- Y K Keung
- Norris Kenneth Jr Cancer Hospital and Research Institute, Los Angeles, CA 90033
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34
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Sugita K, Furukawa T, Tsuchida M, Okawa Y, Nakazawa S, Akatsuka J, Ohira M, Nishimura K. High frequency of etoposide (VP-16)-related secondary leukemia in children with non-Hodgkin's lymphoma. Am J Pediatr Hematol Oncol 1993; 15:99-104. [PMID: 8447565 DOI: 10.1097/00043426-199302000-00013] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PATIENTS AND METHODS We report patients who were treated for non-Hodgkin's lymphoma (NHL) or Ki-1 antigen-positive (Ki-1) lymphoma with a T-8801 protocol that included etoposide (VP-16) and behenoylcytosine arabinoside. RESULTS Secondary acute myeloid leukemia (AML) developed in 5 of 38 NHL and Ki-1 lymphoma patients, and the cumulative risk at 4 years was 18.4%. The median time from the initiation of the chemotherapy to the development of AML was 21 months (range, 13-30). Four patients had a FAB M5 morphology, and one had FAB M2. In four of five examined cases, chromosomal alterations involving the long arm of chromosome 11 were demonstrated at the time of development of AML. None of the 46 NHL patients who we treated with another protocol (B-8801), using significantly higher cumulative doses of VP-16 than in the case of the patients with T-8801 and a different schedule of VP-16 administration, developed secondary AML. CONCLUSIONS The risk of secondary AML possibly related to the use of VP-16 given twice weekly.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asparagine/administration & dosage
- Child
- Child, Preschool
- Chromosome Aberrations
- Chromosomes, Human, Pair 11/ultrastructure
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Doxorubicin/administration & dosage
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Follow-Up Studies
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/epidemiology
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/epidemiology
- Life Tables
- Lymphoma, Non-Hodgkin/drug therapy
- Male
- Mercaptopurine/administration & dosage
- Methotrexate/administration & dosage
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Risk
- Vincristine/administration & dosage
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Affiliation(s)
- K Sugita
- Second Department of Pediatrics, School of Medicine, Dokkyo University, Tochigi-ken, Japan
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35
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Nichols CR, Breeden ES, Loehrer PJ, Williams SD, Einhorn LH. Secondary leukemia associated with a conventional dose of etoposide: review of serial germ cell tumor protocols. J Natl Cancer Inst 1993; 85:36-40. [PMID: 7677934 DOI: 10.1093/jnci/85.1.36] [Citation(s) in RCA: 158] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Case reports have suggested that treatment with high-dose etoposide can result in development of a unique secondary leukemia. PURPOSE This study was designed to estimate the risk of developing leukemia for patients receiving conventional doses of etoposide along with cisplatin and bleomycin. METHODS We reviewed the records at Indiana University of all untreated patients entering clinical trials using etoposide at conventional doses (cumulative dose, 2000 mg/m2 or less) for germ cell cancer between 1982 and 1991. The records of all patients who received a chemotherapy regimen containing etoposide, ifosfamide, or cisplatin after failing to respond to primary chemotherapy were also reviewed. RESULTS Between 1982 and 1991, 538 patients entered serial clinical trials with planned cumulative etoposide doses of 1500-2000 mg/m2 in combination with cisplatin plus either ifosfamide or bleomycin. Of these 538 patients, 348 received an etoposide combination as initial chemotherapy and 190 received etoposide as part of salvage treatment. To date, 315 patients are alive, with median follow-up of 4.9 years, and 337 patients have had follow-up beyond 2 years. Two patients (0.37%) developed leukemia. One developed acute undifferentiated leukemia with a t(4;11) (q21;q23) cytogenetic abnormality 2.0 years after starting etoposide-based therapy, and one developed acute myelomonoblastic leukemia with no chromosome abnormalities 2.3 years after beginning chemotherapy. During this period, several hundred patients were treated with etoposide-based chemotherapy and did not enter clinical trials. Three of these patients are known to have developed hematologic abnormalities, including one patient with acute monoblastic leukemia with a t(11;19)(q13;p13) abnormality. CONCLUSIONS Secondary leukemia after treatment with a conventional dose of etoposide does occur, but the low incidence does not alter the risk-to-benefit ratio of etoposide-based chemotherapy in germ cell cancer. IMPLICATIONS The reports of leukemia associated with high doses of etoposide emphasize the need for diligent follow-up of patients and make careful risk-to-benefit analysis imperative.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bleomycin/administration & dosage
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 4
- Cisplatin/administration & dosage
- Clinical Trials as Topic
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Humans
- Leukemia/chemically induced
- Leukemia/genetics
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Myeloid, Acute/chemically induced
- Male
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Second Primary/chemically induced
- Retrospective Studies
- Salvage Therapy
- Testicular Neoplasms/drug therapy
- Translocation, Genetic
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Affiliation(s)
- C R Nichols
- Department of Medicine, Indiana University School of Medicine, Indianapolis
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36
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Taylor JA, Sandler DP, Bloomfield CD, Shore DL, Ball ED, Neubauer A, McIntyre OR, Liu E. ras oncogene activation and occupational exposures in acute myeloid leukemia. J Natl Cancer Inst 1992; 84:1626-32. [PMID: 1433344 DOI: 10.1093/jnci/84.21.1626] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Epidemiologic studies of acute myeloid leukemias (AMLs) show small increases in risk of disease associated with certain occupations and chemical exposures. PURPOSE This study was designed to determine whether the presence of mutationally activated ras oncogenes in AML are associated with occupational and chemical exposures. METHODS We interviewed 62 patients with newly diagnosed AML (or their next-of-kin), all of whom were enrolled in a national multicenter clinical trial, and 630 healthy control subjects. DNA extracted from patients' pretreatment bone marrow samples was amplified by using the polymerase chain reaction and probed with allele-specific oligonucleotides for activating point mutations at the 12th, 13th, and 61st codons of three protooncogenes: H-ras (also known as HRAS), K-ras (also known as KRAS2), and N-ras (also known as NRAS). RESULTS Patients with ras mutation-positive AML had a higher frequency (six of 10 patients) of working 5 or more years in an a priori high-risk occupation than did patients with ras mutation-negative AML (eight of 52; odds ratio [OR] = 6.8; 95% confidence interval [CI] = 1.3-36). Patients with ras mutation-positive AML were more likely than patients with ras mutation-negative AML to have breathed chemical vapor on the job (OR = 9.1; 95% CI = 1.3-64) or to have had skin contact with chemicals (OR = 6.9; 95% CI = 1.3-37). When ras-positive patients were compared with healthy control subjects, the ORs for occupation and occupational exposures remained elevated, while patients with ras mutation-negative AML showed no increased risk when compared with control subjects. CONCLUSION Activation of ras proto-oncogenes may identify an etiologic subgroup of AML caused by occupation and chemical exposure. IMPLICATION Disease etiology may be better understood if epidemiologic measures of exposure are integrated with molecular assays of the genetic defects responsible for cancer initiation and promotion.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Case-Control Studies
- Codon/drug effects
- Codon/genetics
- Female
- Gene Expression Regulation, Leukemic/genetics
- Genes, ras/drug effects
- Genes, ras/genetics
- Humans
- Leukemia, Erythroblastic, Acute/chemically induced
- Leukemia, Erythroblastic, Acute/epidemiology
- Leukemia, Erythroblastic, Acute/genetics
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/epidemiology
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Myeloid/chemically induced
- Leukemia, Myeloid/epidemiology
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Acute/chemically induced
- Leukemia, Myelomonocytic, Acute/epidemiology
- Leukemia, Myelomonocytic, Acute/genetics
- Male
- Middle Aged
- Mutation
- Occupational Exposure
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Affiliation(s)
- J A Taylor
- Environmental and Molecular Epidemiology Section, National Institute of Environmental Health Sciences, Research Triangle Park, N.C. 27709
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37
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Pedersen-Bjergaard J, Sigsgaard TC, Nielsen D, Gjedde SB, Philip P, Hansen M, Larsen SO, Rørth M, Mouridsen H, Dombernowsky P. Acute monocytic or myelomonocytic leukemia with balanced chromosome translocations to band 11q23 after therapy with 4-epi-doxorubicin and cisplatin or cyclophosphamide for breast cancer. J Clin Oncol 1992; 10:1444-51. [PMID: 1517787 DOI: 10.1200/jco.1992.10.9.1444] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To report five cases of acute monocytic or myelomonocytic leukemia after chemotherapy with 4-epidoxorubicin for breast cancer and to evaluate the risk of leukemia after the use of this drug. PATIENTS AND METHODS One hundred fifty-seven patients with advanced breast cancer were randomized to either 4-epi-doxorubicin plus cisplatin or 4-epi-doxorubicin alone. An additional 203 patients were treated prospectively with 4-epi-doxorubicin alone. All were observed closely for leukemic complications. RESULTS Three patients from the randomized study developed leukemia; all were in the subgroup of 74 patients who received 4-epi-doxorubicin plus cisplatin, whereas no leukemia was observed among the remaining 83 patients in the randomized study or among the additional 203 patients who were treated prospectively with 4-epi-doxorubicin alone (P = .023, log-rank test). In the subgroup of 74 patients who were treated with 4-epi-doxorubicin plus cisplatin, the cumulative risk of leukemia was 16.0% +/- 9.9% (mean +/- SE) 33 months after the start of therapy; the relative risk was 668 (95% confidence interval [Cl], 138 to 1,953). Two other cases of acute monocytic and myelomonocytic leukemia were observed after 4-epi-doxorubicin plus alkylating agents were administered for breast cancer. Three of five cases of leukemia presented balanced translocations to chromosome band 11q23 and two, loss of a whole chromosome no. 7 or its long arm. CONCLUSIONS 4-epi-doxorubicin is leukemogenic, and the leukemias are often acute monocytic or myelomonocytic with balanced chromosome translocations to band 11q23, such as in the leukemias after therapy with the epipodophyllotoxins. Furthermore, our results suggest a synergistic effect in leukemogenesis between 4-epi-doxorubicin targeting DNA-topoisomerase II and directly genotoxic drugs such as cisplatin or alkylating agents.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Chromosomes, Human, Pair 11/drug effects
- Cisplatin/adverse effects
- Cyclophosphamide/adverse effects
- Doxorubicin/adverse effects
- Drug Synergism
- Female
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/chemically induced
- Leukemia, Myelomonocytic, Acute/genetics
- Prospective Studies
- Translocation, Genetic/drug effects
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38
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39
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Fagioli F, Cuneo A, Piva N, Carli MG, Previati R, Balboni M, Tomasi P, Cariani D, Scapoli G, Castoldi G. Distinct cytogenetic and clinicopathologic features in acute myeloid leukemia after occupational exposure to pesticides and organic solvents. Cancer 1992; 70:77-85. [PMID: 1606550 DOI: 10.1002/1097-0142(19920701)70:1<77::aid-cncr2820700113>3.0.co;2-c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND To study the correlation of environmental exposure to potentially mutagenic agents and the clinicopathologic picture in acute myeloid leukemia (AML), clinical features, morphologic characteristics, immunophenotype, and cytogenetics were studied in 59 patients with newly diagnosed AML. METHODS Based on interviews on occupational hazards and hobbies showing prolonged contact with pesticides (18 patients) and organic solvents (7 patients), 25 patients were categorized as "exposed". Thirty-four patients were categorized as "unexposed,", based on anamnestic findings. RESULTS Light microscopic studies showed myelodysplasia involving multiple cell lineages in all assessable patients with professional exposure to pesticides and organic solvents, whereas morphologic aberrations of the non-blast cell population were confined to a minority of cells in unexposed patients. These findings were confirmed by electron microscopic studies in 31 patients. Immunologic analysis showed the presence of a minor megakaryoblastic component in six exposed patients and showed positive findings for the CD34 stem cell marker in 85% of exposed patients, a figure significantly higher as compared with that for unexposed subjects. Cytogenetic studies confirmed the frequent occurrence of 5q and/or 7q aberrations in patients occupationally exposed (10 of 25 cases). Other recurring chromosome aberrations in the exposed group were 17p-, trisomy 11q, and translocation of 16q, 6p, 7p, and 11p, whereas the classic AML-specific translocations (i.e., t[15;17]; t[8;21]) were detected only in unexposed subjects. Conventional chemotherapy achieved complete remission in 1 of 19 exposed patients, as opposed to 14 of 29 unexposed patients, with a median survival of 2 months in the former group and 8 months in the latter. CONCLUSIONS Taken together, these findings document that AML in patients professionally exposed to toxic substances may represent a distinct cytogenetic and clinicopathologic entity. The clinicobiologic characteristics in these exposed patients are similar to the features of AML arising in patients with prior chemotherapy for another tumor, thus suggesting that similar transformation pathways may underlie leukemogenesis induced by cytotoxic drugs and by environmental exposure to some pesticides or organic solvents.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Chromosome Aberrations/physiology
- Female
- Humans
- Immunophenotyping
- Leukemia, Erythroblastic, Acute/chemically induced
- Leukemia, Erythroblastic, Acute/genetics
- Leukemia, Erythroblastic, Acute/pathology
- Leukemia, Megakaryoblastic, Acute/chemically induced
- Leukemia, Megakaryoblastic, Acute/genetics
- Leukemia, Megakaryoblastic, Acute/pathology
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Monocytic, Acute/pathology
- Leukemia, Myeloid/chemically induced
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myelomonocytic, Acute/chemically induced
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/pathology
- Leukemia, Promyelocytic, Acute/chemically induced
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Middle Aged
- Occupational Exposure
- Pesticides/adverse effects
- Solvents/adverse effects
- Time Factors
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Affiliation(s)
- F Fagioli
- Institute of Hematology, University of Ferrara, Italy
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40
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Abstract
In the past five years, several groups have reported acute myeloid leukemia (AML) often monoblastic, as a complication of chemotherapy regimens including the epipodophyllotoxins, etoposide and teniposide. This syndrome is distinct clinically, pathologically and cytogenetically from classical therapy-related myelodysplasia and AML. There is also evidence that other topoisomerase II inhibitors, such as the intercalating agents (including doxorubicin, mitoxantrone, and actinomycin D) may be leukemogenic. Furthermore, there may be further interactions from concomitant topoisomerase II inhibitors and alkylating agents. Topoisomerase II inhibitors induce DNA cleavage and other chromosomal aberrations, including sister chromatid exchanges. These clastogenic abnormalities are not fully understood, and may be specific for each cytotoxic agent. Work is in progress to clone breakpoints such as the t(9;11) and t(8;21) and the use of the resultant DNA probes will enhance our understanding of the leukemogenic process. Given the potential diversity in patients with secondary leukemia, cytogenetic studies should be mandatory for both enhancing our knowledge base and guiding treatment in individual patients. Clinicians must also be wary of the leukemogenic potential of 'dose-intense' regimens including agents such as etoposide and doxorubicin.
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MESH Headings
- Acute Disease
- Antineoplastic Agents/adverse effects
- DNA Damage/genetics
- Humans
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/enzymology
- Leukemia, Monocytic, Acute/genetics
- Leukemia, Myeloid/chemically induced
- Leukemia, Myeloid/enzymology
- Leukemia, Myeloid/genetics
- Neoplasms, Second Primary/enzymology
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Podophyllotoxin/adverse effects
- Topoisomerase II Inhibitors
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Affiliation(s)
- M J Ratain
- Department of Medicine, University of Chicago Pritzker School of Medicine, Illinois
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41
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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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42
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Albain KS, Le Beau MM, Ullirsch R, Schumacher H. Implication of prior treatment with drug combinations including inhibitors of topoisomerase II in therapy-related monocytic leukemia with a 9;11 translocation. Genes Chromosomes Cancer 1990; 2:53-8. [PMID: 2177642 DOI: 10.1002/gcc.2870020110] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The present case, together with other reports reviewed herein, defines a new subtype of therapy-related acute myeloid leukemia (t-AML). This variant of t-AML is characterized by a short interval from initial drug therapy to bone marrow dysfunction and monocytic morphology without trilineage dysplasia. Unlike classic t-AML, which frequently has abnormalities of chromosomes 5 and/or 7, this new subtype is characterized by rearrangements involving band q23 of chromosome 11, most commonly a 9;11 translocation. The majority of patients with this subtype t-AML had prior cytotoxic therapy with topoisomerase II-reactive drugs including anthracyclines, epipodophyllotoxins, or actinomycin D, combined with either an alkylating agent or cisplatin. This association of prior therapy which includes topoisomerase II-reactive agents and a rapidly appearing t-AML involving the monocytic line and chromosome 11 requires additional study.
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MESH Headings
- Alkylating Agents/adverse effects
- Antibiotics, Antineoplastic/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/complications
- Breast Neoplasms/drug therapy
- Breast Neoplasms/therapy
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 9/ultrastructure
- Cisplatin/adverse effects
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Dactinomycin/adverse effects
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Humans
- Iatrogenic Disease
- Leukemia, Monocytic, Acute/chemically induced
- Leukemia, Monocytic, Acute/classification
- Leukemia, Monocytic, Acute/genetics
- Mastectomy, Radical
- Middle Aged
- Podophyllotoxin/adverse effects
- Radiotherapy
- Tamoxifen/administration & dosage
- Topoisomerase II Inhibitors
- Translocation, Genetic
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Affiliation(s)
- K S Albain
- Department of Medicine, Loyola University Stritch School of Medicine, Maywood, IL 60153
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43
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Mahe M, Raffi F, Grolleau JY, Baudot S. [Acute monoblastic leukemia in non-Hodgkin's malignant lymphoma treated with prednimustine]. Therapie 1989; 44:378-9. [PMID: 2814920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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44
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Abe K, Imamura N, Mtasiwa DM, Inada T, Fujimura K, Kuramoto A. [Multiple myeloma following chronic neutrophilia terminated with acute monocytic leukemia (AML, M 5 b)]. Rinsho Ketsueki 1989; 30:910-4. [PMID: 2795904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case of a 70 years old female who developed multiple myeloma during a course of neutrophilia, and later on terminated with acute monocytic leukemia (AML, M 5 b) following Melphalan therapy for five years is reported. This patient was first found to have neutrophilia in 1966, After six years, she developed monoclonal gammopathy, (IgG1 kappa type) which coexisted with the neutrophilia. She was put on Melphalan regimen for 5 years which was discontinued due to anemia, leukocytopenia and the reduction of serum IgG. By routine bone marrow examination, she was diagnosed as AMoL (AML, M 5 b) in July 1984. Thereafter, a combination chemotherapy of BH-AC, 6-MP and prednisolone was started and complete remission for the AMoL was achieved after 2 months. Sixteen months later, she relapsed and a similar combination chemotherapy for reinduction regimen was administered. However, the AMoL was resistant and after 7 months, she died of pneumonia and multiple organ failure. The association of neutrophilia with multiple myeloma, the occurrence of AMoL after prolonged Melphalan therapy for the multiple myeloma and the strategy of therapy for secondary leukemia is discussed.
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45
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DeVore R, Whitlock J, Hainsworth JD, Johnson DH. Therapy-related acute nonlymphocytic leukemia with monocytic features and rearrangement of chromosome 11q. Ann Intern Med 1989; 110:740-2. [PMID: 2648930 DOI: 10.7326/0003-4819-110-9-740] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- R DeVore
- Vanderbilt University, Nashville, Tennessee
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46
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Pedersen-Bjergaard J, Philip P, Ravn V, Hansen SW, Nissen NI. Therapy-related acute nonlymphocytic leukemia of FAB type M4 or M5 with early onset and t(9;11) (p21;q23) or a normal karyotype: a separate entity? J Clin Oncol 1988; 6:395-7. [PMID: 3276828 DOI: 10.1200/jco.1988.6.2.395] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Orazi A, Sozzi G, Delia D, Morandi F, Rottoli L, Cattoretti G. Acute monoblastic leukemia as a second malignancy following chemotherapy for osteogenic sarcoma: a case report. Pediatr Hematol Oncol 1988; 5:39-46. [PMID: 3152950 DOI: 10.3109/08880018809031250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A patient with well-differentiated monoblastic leukemia (ANLL FAB-M5b) is described in whom acute leukemia was diagnosed 25 months after having completed postoperative adjuvant chemotherapy for osteogenic sarcoma of the femur. All analyzed metaphases showed 48xy, dup 1(q12), +3, +9.
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Affiliation(s)
- A Orazi
- Divisione di Anatomia Patologica e Citologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
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Silberberg JM, Zarrabi MH. Acute nonlymphocytic leukemia after thiotepa instillation into the bladder: report of 2 cases and review of the literature. J Urol 1987; 138:402-3. [PMID: 3110436 DOI: 10.1016/s0022-5347(17)43163-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report 2 cases of acute nonlymphocytic leukemia after thiotepa instillation into the bladder for superficial bladder carcinoma and review 4 additional cases from the literature. Intravesical thiotepa is absorbed systemically in patients with bladder carcinoma and such treatment may be associated with the rare occurrence of acute nonlymphocytic leukemia and/or the myelodysplastic syndrome.
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49
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Weh HJ, Kabisch H, Landbeck G, Hossfeld DK. Translocation (9;11)(p21;q23) in a child with acute monoblastic leukemia following 2 1/2 years after successful chemotherapy for neuroblastoma. J Clin Oncol 1986; 4:1518-20. [PMID: 3463672 DOI: 10.1200/jco.1986.4.10.1518] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This is a case report of a 4 1/2-year-old boy who developed acute monoblastic leukemia 2 1/2 years after he had been treated successfully with combined chemotherapy for neuroblastoma. All analyzable bone marrow-derived metaphases had the karyotype 47,XY, + 8,t(9;11)(p21;q23). The rare occurrence of specific chromosomal translocations in leukemias following prior chemotherapy and/or radiotherapy and their possible clinical implications in such cases are discussed.
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50
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