Secondary Leukemia and Myelodysplastic Syndrome in Children with Acute Lymphocytic Leukemia and Non-Hodgkin's Lymphoma Treated with TCCSG Protocol

Abstract

We investigated the occurrence of secondary acute myelocytic leukemia (AML) or myelodysplastic syndrome (MDS) in children with acute lymphocytic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) treated with TCCSG protocol. a) ALL : Secondary AML or MDS developed in seven of 1, 209 ALL patients (cumulative risk at seven years, 1.5%). The median time from the initiation of chemotherapy to the development of secondary AML or MDS was 42 months (range, 18 to 79). Four patients developed AML and 3 developed MDS. b) NHL : Secondary AML developed in eight of 38 NHL patients treated with T-8801 (cumulative risk at 70 months, 27.6%). The median time from initiation of chemotherapy to the development of secondary AML or MDS was 29 months (range, 13 to 66). There were no secondary AML patients among the 50 NHL patients treated with other T-NHL protocols or among the 101 NHL patients treated with B-8801 or B-9201. Secondary AML and MDS were resistant to chemotherapy and showed poor prognosis. Chromosomal translocations involving 11q23 were demonstrated in five of 15 patients with secondary AML or MDS.