Post-therapy secondary leukemia included patients with:
(1) acute myeloblastic leukemia
(2) myelodysplasia (with transformation)
(3) myeloproliferative disorder (with transformation)
(4) acute lymphoblastic leukemia
Parameters:
(1) type of cancer treated
(2) type of chemotherapy received
Types of solid tumors associated with an excess risk for acute leukemia:
(1) Hodgkin's disease (relative risk 6.4)
(2) osteosarcoma (relative risk 5)
Types of chemotherapy associated with an excess risk of acute leukemia:
(1) epipodophyllotoxins (etoposide)
(2) anthracyclines
where:
• Both epipodophyllotoxins and anthracyclines are topoisomerase II inhibitors.
|
Agent
|
Cumulative Dose
|
Relative Risk
|
|
etoposide
|
< 1.2 g per square meter
|
1
|
|
|
1.2 to 6.0 g per square meter
|
7
|
|
|
> 6.0 g per square meter
|
197
|
|
anthracyclines
|
<= 170 mg per square meter
|
1
|
|
|
> 170 mg per square meter
|
7
|
The risk of acute leukemia was not increased after therapy with alkylating agents or radiation therapy.
