Journal of Clinical Oncology, Vol 15, 1583-1586, Copyright © 1997 by American Society of Clinical Oncology

ARTICLES

Secondary acute myelogenous leukemia following safe exposure to etoposide

KC Stine, RL Saylors, JR Sawyer and DL Becton
Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock 72202, USA. stinekimoc@exchange.uams.edu

PURPOSE: To present two patients as illustrations of the risk of developing secondary acute myelogenous leukemia (sAML) when theoretically safe doses of etoposide (VP-16) are 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, doxorubicin, bleomycin, and VP-16 (2 g/m2 total) over 4 months, followed by 25.5 Gy of involved-field radiotherapy. Patient no. 2 was an 11-year-old white boy diagnosed with virus-associated hemophagocytic syndrome (VAHS). He was treated with VP-16 intravenously (IV) and orally (0.3 g and 2.8 g/m2, respectively). RESULTS: Patient no. 1 developed AML 16 months from the diagnosis of Hodgkin's disease. Patient no. 2 developed AML 26 months from diagnosis. Both bone marrows were consistent with French-American-British (FAB) M4 disease. Both patients had abnormalities 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. Clinicians should be cautious in the use of VP- 16 in low-risk diseases.

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