Acute leukemia complicating metastatic breast cancer

Abstract

Acute leukemia occurred in two women after prolonged chemotherapy for metastatic carcinoma of the breast. Palliative radiation therapy was given to both patients within 18 and 22 months, respectively, before the onset of acute leukemia, but the short interval between radiation therapy and the onset of leukemia did not suggest radiation leukemogenesis. Therapy included prolonged administration of cyclophosphamide and chlorambucil and intermittent administration of prednisone, vincristine, 5-fluorouracil, and methotrexate. The second patient received 6 months of hexamethylmelamine therapy in addition.The types of leukemia and the time interval from chemotherapy are similar to reported cases of acute leukemia during alkylating agent therapy of multiple myeloma, chronic lymphocytic leukemia, and carcinoma of the ovary and lung.

Implication of prior treatment with drug combinations including inhibitors of topoisomerase II in therapy‐related monocytic leukemia with a 9;11 translocation

“…T h e median time from initial treatment to bone marrow dysfunction is 4-6 years (Michels et al, 1985;Le Beau et al, 1986). Each of the large series of patients with t-MDS/t-AML includes several patients with breast carcinoma who were treated for prolonged durations with chemotherapy with or without radiotherapy (Davis et al, 1973;Rosner et al, 1978;Groupe Franqais, 1984;Michels et al, 1985;Kantarjian et al, 1986;Le Beau et al, 1986;Kantarjian and Keating, 1987; Whang-Peng et al, 1988). However, neither t-MDS nor t-AML have been reported to occur with increased frequency following adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF), or cyclophosphamide, doxorubicin (Adriamycin), and 5-fluorouracil (CAF) (Holdener et al, 1984;Herring et al, 1986;Henderson and Gelman, 1987;Valagussa et al, 1987).…”

Organizational Safety Culture/Climate and Worker Compliance With Hazardous Drug Guidelines: Lessons From The Blood-Borne Pathogen Experience

“…5,6 Beginning in the mid-1970s potential risks to HCWs were identified based on these drugs' genotoxic characterization, the toxic side effects, and "second" therapyrelated malignancies observed in patients treated with these drugs. [7][8][9][10] In the last 20 years, evidence of worker exposure has accumulated. In both the pharmacy and clinical care areas there is documentation of environmental drug contamination; 11-14 multiple studies have reported increases in genotoxicity measures; [1][2][3][4][15][16][17][18][19] and recovery of drugs in the urine of HCWs has been documented.…”

Risk of second tumors in a cohort of patients with ovarian carcinoma

“…In patients with ovarian carcinoma there is an increased risk of second tumors (5'6), and it has been suggested that this increase is mainly due to germline genetic lesions. It is also a well established fact that the risk of second hematopoietic malignancies is increased in patients who have received chemotherapy (7)(8)(9)(10)(11)(12)(13)(14).…”