TREATMENT OF CHILDREN WITH EPIPODOPHYLLOTOXIN-INDUCED SECONDARY ACUTEMYELOID-LEUKEMIA

BACKGROUND, Secondary acute myeloid leukemia (AML) after treatment wit h epi podophyllotoxins is being observed with increased frequency. The rapeutic options are limited for patients with secondary AML and the r ole of bone marrow transplantation is unclear. METHODS, The authors re port the treatment outcome of a cohort of 17 children who developed ep ipodophyllotoxin-induced secondary AML after therapy for childhood acu te lymphoblastic leukemia (ALL) that included etoposide but no irradia tion or alkylating agents. Thirteen patients (76%) had 11q23 chromosom al abnormalities that were not present at the initial diagnosis of ALL . RESULTS, Remission induction was attempted in 16 children, with 13 ( 81%) achieving a complete remission. After consolidation, 9 of these 1 3 patients received a bone marrow transplant (BMT): 2 with 4-hydropero xycyclophosphamide-purged autologous marrow, 4 from a human leukocyte antigen (HLA)-identical sibling, 1 from a mismatched parental donor, a nd 2 from a matched unrelated donor. One additional child underwent al logeneic BMT without an attempt at reinduction. Of the 10 patients who received transplants, 2 were alive and well 27+ and 36+ months, respe ctively, after BMT. Of the 7 patients who did nor receive a transplant , at last follow-up 1 had survived off therapy for 8 months for recurr ent ALL whereas 6 died of AML. CONCLUSIONS. These data confirm the poo r prognosis of secondary AML after epipodophyllotoxin treatment for ch ildhood ALL. Although patients with secondary AML can achieve a remiss ion, it is usually of brief duration. Allogeneic BMT map offer the pos sibility of long term remission in some of these patients. More inform ation is needed to better define the risks and benefits of epipodophyl lotoxin therapy for childhood ALL. (C) 1997 American Cancer Society.