THERAPY-RELATED ACUTE MYELOGENOUS LEUKEMIA ASSOCIATED WITH 11Q23 CHROMOSOMAL-ABNORMALITIES AND TOPOISOMERASE-II INHIBITORS - REPORT OF 4 ADDITIONAL CASES AND BRIEF COMMENTARY

We report 4 additional cases of therapy-related acute myelogenous leuk emia (t-AML) with the translocation t(9;11)(p22q23). Chemotherapy for the primary malignancy (breast carcinoma in 2, non-Hodgkin's lymphoma in 2) included agents with topoisomerase II inhibitory activity (doxor ubicin in 2; doxorubicin and etoposide in 1; doxorubicin, etoposide an d mitoxantrone in 1) as well as alkylators. In agreement with previous reports, the leukemia was monoblastic (FAB M5 subtype) in all 4 patie nts, with only 1 having prior myelodysplasia, and the latency period f rom primary therapy was relatively short (24-48 months). All patients received potentially curative treatment for the leukemia which include d allogeneic bone marrow transplantation in 3; however, all died (3 of t-AML and 1 of lymphoma). Therapy-related AML associated with exposur e to agents with topoisomerase II inhibitory activity (epipodophylloto xins and anthracyclines) is a distinct entity, the genetic basis and o ptimal treatment of which remain to be determined.