mercaptopurine and Leukemia--Radiation-Induced

A 67 year old male developed a therapy related myelodysplastic process culminating in acute myeloid leukemia 16 years following initial treatment for a large cell lymphoma. A second relapse of this leukemia showed 12% blasts including numerous giant blasts. The presence of giant blasts suggested the possibility of relapsed malignant lymphoma, however, flow cytometry and immunohistochemistry identified them as myeloid and chromosomal analysis revealed a near-tetraploid cell line. No evidence of lymphoma was seen. Although remission was induced with chemotherapy he subsequently relapsed with marrow and/or CNS involvement and was maintained on palliative therapy until he developed sepsis and died, 13 months following the observation of tetraploidy and 33 months following the onset of acute leukemia.

Topics: Acute Disease; Aged; Antineoplastic Combined Chemotherapy Protocols; Blast Crisis; Chromosome Aberrations; Combined Modality Therapy; Cyclophosphamide; Fatal Outcome; Humans; Immunophenotyping; Karyotyping; Leukemia, Myeloid; Leukemia, Radiation-Induced; Lymphoma, Large B-Cell, Diffuse; Male; Mercaptopurine; Methotrexate; Neoplasms, Second Primary; Neoplastic Stem Cells; Palliative Care; Polyploidy; Prednisone; Procarbazine; Recurrence; Vincristine

Three cases of secondary leukemia developing after chemotherapy and/or radiotherapy for myeloma, mycosis fungoides, and non-Hodgkin's lymphoma are reported. The first case was a 51-year-old man with IgG-lambda myeloma, treated with melphalan and prednisolone, who developed acute myelomonocytic leukemia 54 months after the diagnosis of myeloma. The second case was a 54-year-old woman with mycosis fungoides treated with radiation, predonine, and cyclophosphamide, who developed acute megakaryoblastic leukemia 298 months after the diagnosis of mycosis fungoides. The third case was a 35-year-old woman with stage IV non-Hodgkin's lymphoma treated with VEMP who developed acute myelogenous leukemia 26 months after the diagnosis of malignant lymphoma. All cases showed pancytopenia and two of three cases had morphologic abnormality in several hemopoietic cell lineages in the leukemic stage. There is a possibility that second malignancies are an increasingly recognized complication in the patients treated with a large amount of chemo-radiotherapy.

Topics: Adult; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Female; Humans; Leukemia; Leukemia, Megakaryoblastic, Acute; Leukemia, Myeloid, Acute; Leukemia, Radiation-Induced; Lymphoma, Non-Hodgkin; Male; Melphalan; Mercaptopurine; Middle Aged; Multiple Myeloma; Mycosis Fungoides; Pancytopenia; Prednisolone; Vincristine

Topics: Acute Disease; Adult; Aged; Bloodletting; Busulfan; Evaluation Studies as Topic; Female; Humans; Leukemia; Leukemia, Radiation-Induced; Male; Mercaptopurine; Middle Aged; Phosphorus Radioisotopes; Polycythemia Vera; Thromboembolism; Veins

A case report of a patient who developed acute myelogenous leukemia 15 years after injection of Thorotrast and who has been in a sustained long term remission for 14 years is presented with a review of the problems associated with Thorotrast, subsequently shown to be radioactive with long term sequelae.

Topics: Adolescent; Angiography; Female; Humans; Leukemia, Myeloid, Acute; Leukemia, Radiation-Induced; Lymph Nodes; Mercaptopurine; Remission, Spontaneous; Spleen; Thorium Dioxide

Topics: Animals; Female; Leukemia, Experimental; Leukemia, Radiation-Induced; Male; Mercaptopurine; Mice; Radiation Effects; Time Factors

Topics: Adenocarcinoma; Alkylation; Animals; Antimetabolites; Carcinoma, Ehrlich Tumor; Glutamine; Leukemia, Experimental; Leukemia, Radiation-Induced; Mammary Neoplasms, Experimental; Mercaptopurine; Mice; Neoplasm Transplantation; Sarcoma 180

Topics: Humans; Hyperthyroidism; Iodine; Iodine Isotopes; Leukemia; Leukemia, Radiation-Induced; Mercaptopurine; Prednisolone; Radiation; Radioisotopes