Acute myelogenous leukemia after exposure to strontium-89 for the treatment of adenocarcinoma of the prostate

BACKGROUND. Strontium-89 is a pure B-emitting radioactive analogue of calci um that has been shown to be beneficial in the palliation of pain due to os seous metastases from adenocarcinoma of the prostate. The most significant reported toxicity is dose-related, reversible, myelosuppression characteriz ed primarily by thrombocytopenia. METHODS. A report of two patients in whom acute myelogenous leukemia (AML) developed after treatment with strontium-89 and a review of the literature are presented. RESULTS. The two patients described in the current study developed AML 17 m onths and 26 months, respectively, after exposure to strontium-89 for the t reatment of prostate carcinoma. To the authors' knowledge these patients re present the first two reported cases of AML after strontium-89 therapy for prostate carcinoma. CONCLUSIONS. The results of the current study suggest the leukemogenic pote ntial of strontium-89 treatment in humans. To the authors' knowledge, the c urrent study represents the first report of AML after therapeutic exposure to strontium-89. As this agent is used more frequently (and earlier in the disease course) in patients with prostate carcinoma, an increased incidence of secondary AML complicating the clinical management of patients with pro state carcinoma may be observed. (C) 2000 American Cancer Society.