1/79. Secondary chronic myelogenous leukemia after chemotherapy followed by adjuvant radiotherapy for small cell lung cancer. A 40-year old patient with small cell lung cancer (SCLC) was treated with combined modalities including high-dose chemotherapy with subsequent autologous peripheral blood progenitor cell transplantation plus adjuvant radiotherapy. He achieved complete remission with regards to the primary disease. After an interval of 28 months, he was diagnosed with chronic myelogenous leukemia (CML). Analysis of graft samples at time of primary treatment for SCLC using polymerase chain reaction (PCR) did not show the bcr-abl transcript characteristic for CML. This case supports the observation that CML can develop as a treatment-related malignancy and gives insight in the length of the preclinical phase of the disease. ( info) |
2/79. Observations on polycythemia vera turning into acute or chronic granulocytic leukemia during treatment with radioactive phosphorus 32P. In a group of 172 cases of polycythemia vera treated with radioactive phosphorus acute granulocytic leukemia developed in 3 and chronic granulocytic leukemia in 6 cases. The author believes that development of acute granulocytic leukemia during this treatment may be considered with some probability as a result of the leukemia-inducing action of ionizing radiation. Transition of polycythemia vera into chronic granulocytic leukemia seems to be a natural outcome of this complex myeloproliferative syndrome in patients with survival prolonged by treatment with 32P. ( info) |
| BACKGROUND: strontium-89 is a pure Beta-emitting radioactive analogue of calcium that has been shown to be beneficial in the palliation of pain due to osseous metastases from adenocarcinoma of the prostate. The most significant reported toxicity is dose-related, reversible, myelosuppression characterized primarily by thrombocytopenia. methods: A report of two patients in whom acute myelogenous leukemia (AML) developed after treatment with strontium-89 and a review of the literature are presented. RESULTS: The two patients described in the current study developed AML 17 months and 26 months, respectively, after exposure to strontium-89 for the treatment of prostate carcinoma. To the authors' knowledge these patients represent the first two reported cases of AML after strontium-89 therapy for prostate carcinoma. CONCLUSIONS: The results of the current study suggest the leukemogenic potential of strontium-89 treatment in humans. To the authors' knowledge, the current study represents the first report of AML after therapeutic exposure to strontium-89. As this agent is used more frequently (and earlier in the disease course) in patients with prostate carcinoma, an increased incidence of secondary AML complicating the clinical management of patients with prostate carcinoma may be observed. [See editorial on pages 497-9, this issue.] copyright 2000 american cancer society. ( info) |
4/79. Fourteen-year remission of acute leukemia in a patient exposed to thorotrast. A case report of a patient who developed acute myelogenous leukemia 15 years after injection of Thorotrast and who has been in a sustained long term remission for 14 years is presented with a review of the problems associated with Thorotrast, subsequently shown to be radioactive with long term sequelae. ( info) |
5/79. Acute myeloid leukaemia complicating a breast cancer after mastectomy and radiotherapy. The author reports a patient treated three years ago for a breast carcinoma. High doses of X-ray had been delivered after radical mastectomy. The possible relationship between this exposure and a rapidly fatal acute myeloid leukemia is emphasized. ( info) |
6/79. A novel syndrome of radiation-associated acute myeloid leukemia involving AML1 gene translocations. AML1 is a transcriptional activator that is essential for normal hematopoietic development. It is the most frequent target for translocations in acute leukemia. We recently identified 3 patients in whom pancytopenia developed almost 50 years after high-level radiation exposure from nuclear explosions during or after world war ii. In all 3 patients, acute myeloid leukemia (AML) eventually developed that had similar characteristics and clinical courses. cytogenetics from the 3 patients revealed a t(1;21)(p36;q22), a t(18;21)(q21;q22), and a t(19;21)(q13.4;q22). By fluorescent in situ hybridization (FISH), all 3 translocations disrupted the AML1 gene. Two of these AML1 translocations, the t(18;21) and the t(19;21), have not been reported previously. It is possible that the AML1 gene is a target for radiation-induced AML. (blood. 2000;95:4011-4013) ( info) |
7/79. The beginnings of radioiodine therapy of metastatic thyroid carcinoma: a memoir of Samuel M. Seidlin, M. D. (1895-1955) and his celebrated patient. Emerging from a stimulating encounter over fifty years ago between Dr. S. M. Seidlin and a celebrated patient at Montefiore Hospital in new york city are a number of findings that bear significantly on the contemporary practice of medicine relating to targeted radioisotope therapy. In 1943, Seidlin administered radioiodine to this patient, who was hyperthyroid although previously thyroidectomized, but who had several metastases from adenocarcinoma of the thyroid which localized the radioisotope. Seidlin recognized early that some thyroid metastases would take up radioiodine (i.e., function), but only after the normal thyroid gland was ablated, an essential preliminary procedure before radioiodine therapy should be administered, the clinical practice followed to this day. He held that removing the normal thyroid increased TSH production and eliminated the gland's competition for radioiodine, inducing the metastases to function. From 1942 until his death in 1955, Seidlin and his group followed many patients having metastatic thyroid carcinoma, conducting fruitful investigations concerned with the induction of function, dosimetry, and the occurrence of leukemia in some massively treated patients. ( info) |
8/79. Secondary acute myeloblastic leukaemia (AML) (expressing 11q23 mutation) occurring 11 months after chemotherapy/radiotherapy for paediatric non-Hodgkin lymphoma (NHL). The occurrence of 11q23 cytogenetic abnormalities in drug-induced acute myeloid leukaemia (AML) is now well recognized. They are most frequently associated with topoisomerase II inhibitor administration. We here describe the case history of a 15-year-old child who presented with Stage III B-cell non-Hodgkin's lymphoma (NHL) and was treated with anthracyclines, alkylating agents and low-dose mediastinal radiotherapy. She developed an 11q23 mutation-related secondary AML at 11 months after therapy (15 months after her first exposure to drugs; 12 months after the first radiotherapy exposure), possibly the earliest yet reported in a paediatric patient. We discuss this newly recognized early form of refractory, secondary AML and its relationship to chemoradiotherapy. ( info) |
9/79. t(3;11) translocation in treatment-related acute myeloid leukemia fuses MLL with the GMPS (GUANOSINE 5' MONOPHOSPHATE SYNTHETASE) gene. The partner gene of MLL was identified in a patient with treatment-related acute myeloid leukemia in which the karyotype suggested t(3;11)(q25;q23). Prior therapy included the dna topoisomerase ii inhibitors, teniposide and doxorubicin. Southern blot analysis indicated that the MLL gene was involved in the translocation. cDNA panhandle polymerase chain reaction (PCR) was used, which does not require partner gene-specific primers, to identify the chimeric transcript. Reverse-transcription of first-strand cDNAs with oligonucleotides containing known MLL sequence at the 5' ends and random hexamers at the 3' ends generated templates with an intra-strand loop for PCR. In-frame fusions of either MLL exon 7 or exon 8 with the GMPS (GUANOSINE 5'-MONOPHOSPHATE SYNTHETASE) gene from chromosome band 3q24 were detected. The fusion transcript was alternatively spliced. guanosine monophosphate synthetase is essential for de novo purine synthesis. GMPS is the first partner gene of MLL on chromosome 3q and the first gene of this type in leukemia-associated translocations. (blood. 2000;96:4360-4362) ( info) |
10/79. Acute promyelocytic leukemia developing after radiotherapy for prostate cancer in a patient with chronic lymphocytic leukemia. Chronic lymphocytic leukemia (CLL) is rarely associated with secondary acute myelogenous leukemia (AML) usually due to chemotherapy or radiotherapy. No cases of concomitant CLL and acute promyelocytic leukemia (APL) have been found in the literature. Nevertheless, up to 12% of therapy-related AML cases are classified as APL. Of these latter, most are related to topoisomerase treatment, with a few acute cases occurring after radiotherapy. We report here a patient with an untreated CLL who developed APL 2 years after radiotherapy for prostate carcinoma. ( info) |