Acute Leukemia as a Secondary Malignancy in Children and Adolescents Current Findings and Issues

被引:85
作者
Hijiya, Nobuko [1 ,2 ]
Ness, Kirsten K. [3 ]
Ribeiro, Raul C. [4 ,5 ]
Hudson, Melissa M. [3 ,4 ,5 ]
机构
[1] Childrens Mem Hosp, Div Hematol Oncol & Stem Cell Transplant, Chicago, IL 60614 USA
[2] Northwestern Univ, Dept Pediat, Chicago, IL 60611 USA
[3] St Jude Childrens Res Hosp, Dept Epidemiol & Canc Control, Memphis, TN 38105 USA
[4] St Jude Childrens Res Hosp, Dept Oncol, Memphis, TN 38105 USA
[5] Univ Tennessee, Hlth Sci Ctr, Dept Pediat, Memphis, TN USA
关键词
secondary leukemia; cancer survivor; epipodophyllotoxins; alkylating agents; acute myeloid leukemia; myelodysplastic syndrome; acute lymphoblastic leukemia; ACUTE LYMPHOBLASTIC-LEUKEMIA; ACUTE MYELOID-LEUKEMIA; THERAPY-RELATED MYELODYSPLASIA; ACUTE MYELOGENOUS LEUKEMIA; TERM FOLLOW-UP; BONE-MARROW-TRANSPLANTATION; CHILDHOOD HODGKINS-DISEASE; COLONY-STIMULATING FACTOR; BREAST-CANCER; LEUKEMIA/MYELODYSPLASTIC SYNDROME;
D O I
10.1002/cncr.23988
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Secondary acute leukemia is a devastating complication in children and adolescents who have been treated for cancer. Secondary acute lymphoblastic leukemia (s-ALL) was rarely reported previously but can be distinguished today from recurrent primary ALL by comparison of immunoglobulin and T-cell receptor rearrangement. Secondary acute myeloid leukemia (s-AML) is much more common, and some cases actually may be second primary cancers. Treatment-related and host-related characteristics and their interactions have been identified as risk factors for s-AML. The most widely recognized treatment-related risk factors are alkylating agents and topoisomerase II inhibitors (epipodophyllotoxins and anthracyclines). The magnitude of the risk associated with these factors depends on several variables, including the administration schedule, concomitant medications, and host factors. A high cumulative dose of alkylating agents is well known to predispose to s-AML. The prevalence of alkylator-associated s-AML has diminished among pediatric oncology patients with the reduction of cumulative alkylator dose and limited use of the more leukemogenic alkylators. The best-documented topoisomerase II inhibitor-associated s-AML is s-AML associated with epipodophyllotoxins. The risk of s-AML in these cases is influenced by the schedule of drug administration and by interaction with other antineoplastic agents but is not consistently found to be related to cumulative dose. The unpredictable risk of s-AML after epipodophyllotoxin therapy may discourage the use of these agents, even in patients at a high risk of disease recurrence, although the benefit of recurrence prevention may outweigh the risk of s-AML. Studies in survivors of adult cancers suggest that, contrary to previous beliefs, the outcome of s-AML is not necessarily worse than that of de novo AML when adjusted for cytogenetic features. More studies are needed to confirm this finding in the pediatric patient population. Cancer 2009;115:23-35. (C) 2008 American Cancer Society.
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页码:23 / 35
页数:13
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