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Therapy of secondary leukemia

Leukemia volume 16, pages 748–750 (2002)Cite this article

Secondary leukemia is a collective term used to describe a group of patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) who have a history of environmental, occupational or therapeutic exposure to hematotoxins or radiation. Patients with AML evolving from antecedent myelodysplasia or other myeloid stem cell disorders, such as polycythemia vera or paroxysmal nocturnal hemoglobinuria, are included in this group. Therapy-related MDS or therapy-related AML are also terms used to describe this syndrome, emphasizing important differences from AML that arises de novo. The term ‘secondary leukemia’ implies that the disease did not develop as a primary or de novo process. It should not be confused with leukemia that occurs as a second primary cancer. Response to therapy and prognosis are primarily determined by the cytogenetic findings. The clinical status of the patient with long-term MDS who now evolves to AML would also impact on the prognosis. It thus seems appropriate that secondary leukemias should be redefined as any leukemia with a specific cytogenetic or molecular poor prognostic feature, due to a presumed predisposing factor, rather than an emphasis on historical exposure.1,2

The most important group among the therapy-related leukemias is the one following therapy with alkylating agents which is usually associated with specific cytogenetic abnormalities in chromosomes 5 or 7.3 An important group, although less frequent, are the leukemias following treatment with topoisomerase II inhibitors, usually characterized by the 11q abnormalities. Also, however, there is a small but important group of therapy-related leukemias following other miscellaneous therapies which may be characterized by other cytogenetic abnormalities including t(15;17), inv(16) and even the t(8;21). Thus, conventionally defined secondary leukemias represent a heterogeneous group of diseases with different cytogenetic abnormalities and different prognoses. For example, patients with the so-called secondary leukemia having cytogenetics generally recognized to have a more favorable prognosis, such as t(8;21), t(15;17) and inv(16), have a response rate and long-term survival that are exactly what one would expect from de novo AML having the same cytogenetic abnormalities.4 Furthermore, one of the largest prospective studies of adult AML where the data were rigorously analyzed by cytogenetics, is the AML 10 study conducted by the Medical Research Council in the UK.5 In this report 119 patients had the so-called classic secondary leukemias and all received identical standard therapy. Interestingly, but not surprisingly, the response rate depended entirely on the cytogenetic group, very much as one would expect from any de novo AML.

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  1. Rambam Medical Center and Technion, Haifa, Israel

    JM Rowe

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This paper is part of a series of keynote addresses to be published in Leukemia. They were presented at the Acute Leukemia Forum, San Francisco, 20 April 2001. Supported by an unrestricted educational grant from Immunex.

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Rowe, J. Therapy of secondary leukemia. Leukemia 16, 748–750 (2002). https://doi.org/10.1038/sj.leu.2402456

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