SECONDARY HEMATOLOGICAL NEOPLASM AFTER TREATMENT OF ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA - ANALYSIS OF 1170 ADULT ALL PATIENTS ENROLLED IN THE GIMEMA TRIALS

Between 1983 and 1994 the incidence of secondary haematological neopla sms (SHM) was evaluated in 1170 new cases of ALL enrolled in the GIMEM A trials. Of the 942 patients who achieved complete remission (CR); se ven developed a SHM: four AMLs and three NHLs. The median latency from onset of ALL and of secondary haematological neoplasm was 69 months f or AML and 61 months for NHL. Three out of four patients with secondar y AML were unresponsive to the new chemotherapy and died, whereas the fourth patient achieved a new CR. Among the three NHL cases, two patie nts are presently alive in CR, whereas the third patient was refractor y to chemotherapy and died, The relative risk of haematological malign ancy among the GIMEMA trials population, as compared to that of the It alian Cancer Registries, was 15.25-fold higher, and the actuarial esti mated cumulative proportion of ALL patients with a secondary haematolo gical neoplasm at 5 and 10 years were 0.59% and 3.63% respectively, Th e incidence of adult ALL who developed a SHM, although apparently lowe r than in the paediatric ALL series, was higher when compared to the n ormal population. The difference between paediatric and adult ALL is p robably due to the lack of craniospinal radiotherapy and to the lower doses of epipodoxiphyllotoxins used in adult trials. The higher percen tage of childhood ALL with a prolonged event-free survival could resul t in an increase of secondary neoplasms in these cases, which suggests that secondary haematological neoplasms in adult ALL patients are rea l, although rare, events.