Acute monoblastic leukemia in a child following chemotherapy for neuroblastoma

The long-term effects of childhood cancer and its therapy are serious probl ems that deserve attention. One of the most important late effects is the d evelopment of secondary malignancy. We encountered a girl with neuroblastom a who developed acute monoblastic leukemia as a secondary malignancy, 32 mo nths after starting treatment for the primary tumor at the age of 4 years a nd 10 months. For the primary tumor, she had received cyclophosphamide, ifo sphamide, etoposide, epirubicin, cisplatin, and vincristine during a period of 20 months; no radiotherapy was given. Cytogenetic analysis of the leuke mic cells showed no specific changes, but a rearrangement of the mixed line age leukemia gene (chromosome 11q23 translocation) was subsequently found b y reverse transcription polymerase chain reaction. The survival time after onset of the secondary malignancy was brief. The leukemogenic hazards of ca ncer treatment should be weighed against their therapeutic benefits.