Secondary acute myelogenous leukemia in patients previously treated for childhood renal tumors: A report from the National Wilms Tumor Study Group

Purpose: This review characterized cases of secondary acute myelogenous leu kemia (AML) occurring after treatment of renal neoplasms on protocols of th e National Wilms Tumor Study Group (NWTSG) between October 1969 and Decembe r 1991. Patients and Methods: The NWTSG database was reviewed for cases of secondar y AML and for WT1 status of the affected patients. Referring institutions w ere contacted by a confidential letter requesting pathology reports, result s of immunophenotyping. cytogenetic, and molecular analyses, and details co ncerning treatment of AML. Results: Of the 5,278 patients treated during the study period, 43 had seco nd malignant neoplasms, and 7 of these 43 had AML. At the time of diagnosis of Wilms tumor. the median age of the seven patients (4 boys) was 3.2 year s. Five of the seven renal neoplasms had favorable histologic characteristi cs. The most common French-American-British morphology was M5. One patient had bilateral tumors, and two were treated for recurrent Wilms tumor. All p atients received chemotherapy regimens that included doxorubicin (6) or eto poside (I), and six were treated with infradiaphragmatic irradiation. The m edian latency period from initial diagnosis of the renal neoplasm to develo pment of secondary AML was 3 years (range, 1.2-4 yrs). One patient had the translocation t(9;11)(p22:q23); WT1 status was not noted for any of the sev en patients. Conclusions: The development of secondary AML in this subset of patients af ter treatment of renal neoplasms may reflect the interaction of the effects of treatment and possible genetic predisposition toward cancer.