ACUTE MYELOMONOCYTIC LEUKEMIA SECONDARY TO SYNCHRONOUS CARCINOMAS OF THE BREAST AND LUNG, AND TO METACHRONOUS RENAL-CELL CARCINOMA

We describe a patient in whom synchronous breast cancer and small-cell lung cancer, and metachronous renal cell carcinoma were diagnosed wit hin an 11 months period. All three tumors were treated surgically, fol lowed by administration of tamoxifen, adjuvant chemotherapy with etopo side (2.8 g/m(2) total) and vindesine, and admin istration of interfer on alpha and flutamide. The patient developed acute myelomonocytic leu kemia 26 months after discontinuation of etoposide-containing chemothe rapy. This pattern of multiple neoplasms fits the wider disease spectr um associated with germline mutations of the p53 gene; however, analys is of p53 exons 5-8 did not disclose any sequence abnormalities in thi s patient. In conclusion, clustering of four (synchronous and metachro nous) malignancies may on rare occasions occur in an individual patien t and in the absence of a family history of cancer; the sequence durin g which treatment of primary malignancies may result in treatment-rela ted acute myelocytic leukemia is discussed.