Treatment-Associated Leukemia Following Testicular Cancer

Travis, Lois B.; Andersson, Michael; Gospodarowicz, Mary K.; Leeuwen, Flora E. van; Bergfeldt, Kjell; Lynch, Charles F.; Curtis, Rochelle E.; Kohler, Betsy A.; Wıklund, Tom; Storm, Hans H.; Holowaty, Eric J.; Hall, Per; Pukkala, Eero; Sleijfer, Dirk; Clarke, E. Aileen; Boice, John D.; Stovall, Marilyn; Gilbert, Ethel S.

doi:10.1093/jnci/92.14.1165

Cited by 237 publications

(169 citation statements)

References 31 publications

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“…No patient developed myelodysplasia or secondary leukemia after HDCT, even though an increased incidence was reported in the major studies. 24,25 The incidence of late symptomatic neurotoxicity and ototoxicity is comparable to the reported frequencies in previous studies with standard-dose chemotherapy, while no patient presented cardiac or renal failure. 26 The results of our experience are comparable to those reported in other studies with early HDCT in GCT patients with poor prognosis disease, as defined by the IGCCCG criteria, but for the first time we confirmed the outcome of these patients at long-term follow-up.…”

Section: Discussionsupporting

confidence: 80%

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Giorgi

Rosti

Papiani

et al. 2004

Bone Marrow Transplant

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Summary:The 5-year overall survival rate of patients with germ cell tumor (GCT) with poor prognosis, according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification, is 48% after standard-dose chemotherapy and surgery, if necessary. Two recent studies have showed that early high-dose chemotherapy (HDCT) with hematopoietic progenitor cell support (HPCS) may induce a 2-year overall survival rate of 78% in these patients. We report the long-term results of the experience at the Department of Oncology in Ravenna with early HDCT and HPCS in GCT patients with poor prognosis (IGCCCG criteria). Between 1987 and 2002, 18 poor prognosis GCT patients (17 M, one F), median age 24.5 years (range, 17-52), were treated with early HDCT with HPCS. In total, (67%) patients achieved a complete remission and they are continuously disease-free at a median follow-up of 9.2 years (range, 1.7-16.2). One treatment-related death occurred. No patient developed myelodysplasia or a secondary leukemia. This is notably the longest follow-up reported in patients having received HDCT in this setting. No patient achieving a complete remission relapsed. The role of HDCT in poor prognosis GCT will be defined from the ongoing phase III randomized trials.

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Section: Discussionsupporting

confidence: 80%

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Giorgi

Rosti

Papiani

et al. 2004

Bone Marrow Transplant

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“…leukemia is reported as approximately 2-to 3-fold in most studies. 7,[9][10][11] In the current series, the risk of secondary leukemia was increased by 72% in patients who received pelvic radiotherapy compared with subjects with pelvic malignancies not treated with radiation.…”

Section: Discussionmentioning

confidence: 52%

“…Prior work has consistently shown an association between radiation and secondary leukemia. [7][8][9][10][11][12][13][14] Whereas the association between radiation and leukemia is strongest for acute myeloid leukemia, radiation also increases the risk of acute lymphocytic leukemia and chronic myeloid leukemia. In contrast, there does not appear to be a link between radiation and chronic lymphocytic leukemia.…”

Section: Discussionmentioning

confidence: 99%

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Pelvic radiotherapy and the risk of secondary leukemia and multiple myeloma

Wright

Clair

Deutsch

et al. 2010

Cancer

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BACKGROUND: Although several studies had examined secondary malignancies in patients with specific primary tumor types, to the authors' knowledge there are very few data examining the long-term sequelae of pelvic radiation as a whole. The goal of the current study was to examine the risk of treatment-associated leukemia and multiple myeloma in patients treated with pelvic radiotherapy. METHODS: Patients with invasive tumors of the vulva, cervix, uterus, anus, and rectosigmoid treated from 1973 to 2005 and recorded in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Patients were stratified based on receipt of pelvic radiotherapy. The incidence of secondary leukemia (except chronic lymphocytic leukemia) and multiple myeloma were examined. Multivariate Cox proportional hazards models and Kaplan-Meier curves were constructed to examine the association between pelvic radiation and the development of subsequent hematologic malignancies. RESULTS: A total of 199,268 individuals, including 66,896 (34%) who received pelvic radiotherapy and 132,372 (66%) not treated with radiation, were identified. In a Cox proportional hazards model adjusting for other risk factors, post-treatment leukemia was increased by 72% (hazard ratio [HR], 1.72; 95% confidence interval [95% CI], 1.37-2.15) in the patients who received pelvic radiotherapy. The risk of secondary leukemia peaked at 5 to 10 years after primary treatment (HR, 1.85; 95% CI, 1.40-2.44) and remained elevated even 10 to 15 years after initial treatment (HR, 1.50; 95% CI, 1.03-2.18). There was no significant association between radiation and the development of multiple myeloma (HR, 1.08; 95% CI, 0.81-1.44). CONCLUSIONS: Pelvic radiation was associated with an increased risk of secondary leukemia but did not appear to increase the risk of multiple myeloma. Cancer 2010;116:2486-92.

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“…33 No patient developed myelodysplasia or secondary leukemia after receiving HDCT, even though an increase was reported in other experiences. 34,35 In conclusion, there has been much progress in the understanding of HDCT for patients with GCT in the past years. Currently, it is of great importance to rapidly complete ongoing randomized trials to validate the hypothesis of improved survival in the first salvage therapy for incomplete responders or for those with recurrent disease in the first-line treatment for patients with a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Salvage high‐dose chemotherapy in patients with germ cell tumors

Rosti

Giorgi

Salvioni³

et al. 2002

Cancer

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BACKGROUNDHigh‐dose chemotherapy (HDCT) followed by hematopoietic stem cell support (HSCS) potentially may be curative in patients with germ cell tumor (GCT) who develop recurrent tumors or who have an inadequate response after receiving standard‐dose chemotherapy. The authors report their experience with HDCT as salvage therapy for patients with GCT.METHODSBetween 1986 and 2000, 84 patients with GCT, with a median age 29 years (range, 15–50 years), were treated with 105 courses of HDCT with HSCS. Patients were stratified into good, intermediate, and poor risk categories according to a validated prognostic index.RESULTSOverall, 28 patients (33%) have been continuously disease free. In the good risk group, 24 patients (69%) have been continuously disease free compared with 4 patients (13%) in the intermediate risk group (P < 0.001) and 0 patients in the poor risk group (P < 0.001). Treatment‐related mortality occurred only among patients in the poor risk (n = 6 patients) and the intermediate risk groups (n = 4 patients).CONCLUSIONSIn the authors' experience, HDCT induced impressive long‐term remissions as salvage treatment among patients in the good risk group. Moreover, the use of validated prognostic classifications may contribute to a better definition of the role of HDCT other than improving the outcome of patients with GCT. The definitive statement on the possible role of HDCT in patients with GCT will derive from the ongoing Phase III randomized studies. Cancer 2002;95:309–15. © 2002 American Cancer Society.DOI 10.1002/cncr.10672

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Treatment-Associated Leukemia Following Testicular Cancer

Cited by 237 publications

References 31 publications

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Long-term follow-up of patients with poor prognosis germ cell tumor treated with early high-dose chemotherapy with hematopoietic progenitor cell support: a single-center experience

Pelvic radiotherapy and the risk of secondary leukemia and multiple myeloma

Salvage high‐dose chemotherapy in patients with germ cell tumors

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