SECONDARY ACUTE MYELOGENOUS LEUKEMIA FOLLOWING SAFE EXPOSURE TO ETOPOSIDE

Purpose: To present two patients as illustrations of the risk of devel oping secondary acute myelogenous leukemia (sAML) when theoretically s afe doses of etoposide (VP-16) ore used. Patients and Methods: Patient no, 1 was a 15-year-old white girl diagnosed with stage IIa Hodgkin's disease. She was treated with a combination of vincristine, doxorubic in, bleomycin, and VP-16 (2 g/m(2) total) over 4 months, followed by 2 5.5 Gy of involved-field radiotherapy. Patient no. 2 was an 11-year-ol d white boy diagnosed with virus-associated hemophagocytic syndrome (V AHS). He was treated with VP-16 intravenously (IV) and orally (0.3 g a nd 2.8 g/m(2), respectively). Results: Patient no. 1 developed AML 16 months from the diagnosis of Hodgkin's disease. Patient no. 2 develope d AML 26 months from diagnosis. Both bone marrows were consistent with French-American-British (FAB) M4 disease. Both patients had abnormali ties of the long arm of chromosome 11. Conclusion: The use of low-dose or oral VP-16 can be associated with the development of sAML. Clinici ans should be cautious in the use of VP-16 in low-risk diseases. (C) 1 997 by American Society of Clinical Oncology.