This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Houck, W. Articles by Einhorn, L. H. Search for Related Content PubMed PubMed Citation Articles by Houck, W. Articles by Einhorn, L. H. Social Bookmarking                            What's this?

Secondary Leukemias in Refractory Germ Cell Tumor Patients Undergoing Autologous Stem-Cell Transplantation Using High-Dose Etoposide

From the Division of Hematology-Oncology and the Department of Medical and Molecular Genetics, Indiana University Medical Center and Walther Cancer Institute, Indianapolis, IN.

Address reprint requests to Lawrence H. Einhorn, MD, Indiana Cancer Pavilion, 535 Barnhill Dr, RT #473, Indianapolis, IN 46202-5289; e-mail: Leinhorn{at}iupui.edu

PURPOSE: To quantify the risk of secondary leukemias in relapsed testicular cancer patients undergoing autologous stem-cell transplantation with high-dose etoposide.

PATIENTS AND METHODS: Single institution, retrospective study of germ cell tumor patients who underwent autologous transplantation using high-dose etoposide from 1987 to 2001.

RESULTS: One hundred thirteen patients received high-dose etoposide and carboplatin followed by autologous stem-cell transplantations for germ cell tumors. Follow-up ranged from 12 to 166 months (median, 51 months). Three patients (2.6%; 95% CI, 0.55% to 7.50%) subsequently developed leukemia at an average of 16 months post–autologous transplantation (range, 11 to 21 months). All three had received tandem transplantations and had been heavily pretreated, including at least one prior cycle of etoposide. Following autologous transplantation, all three patients exhibited refractory cytopenias before developing overt leukemia. All leukemias were of myeloid lineage. One patient developed an M2 with a t(8,21) chromosomal translocation; another, an M5 with a t(11,19); and one patient exhibited an unclassified leukemia with cytogenetic abnormalities resulting in monosomy for 7p and partial monosomy of 7q. Treatment of the leukemias involved allogeneic bone marrow transplantation.

CONCLUSION: High-dose chemotherapy using high-dose etoposide as therapy for relapsed germ cell tumors was associated with a 2.6% risk of developing a secondary myeloid leukemia. This figure was not significantly different from the expected rate of secondary leukemias when patients receive additional cycles of standard-dose etoposide as salvage chemotherapy for germ cell tumors. Other factors, including the use of platinum agents, may also have a role in leukemogenesis in this patient population.

Presented in part at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31-June 3, 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				G. Leone, L. Pagano, D. Ben-Yehuda, and M. T. Voso Therapy-related leukemia and myelodysplasia: susceptibility and incidence Haematologica, October 1, 2007; 92(10): 1389 - 1398. [Abstract] [Full Text] [PDF]

				L. H. Einhorn, S. D. Williams, A. Chamness, M. J. Brames, S. M. Perkins, and R. Abonour High-Dose Chemotherapy and Stem-Cell Rescue for Metastatic Germ-Cell Tumors N. Engl. J. Med., July 26, 2007; 357(4): 340 - 348. [Abstract] [Full Text] [PDF]