Abstract
Background:
Reports have implied etoposide as the cause of secondary leukaemia in patients treated for germ cell cancer.
Patients and methods:
Between 1979 and 1992, 679 male patients with germ cell cancer received etoposide containing chemotherapy.
Results:
Six of 679 patients developed acute myeloid leukaemia (relative risk 150; CI: 55-326). None of these patients had a primary mediastinal germ cell tumour and only 1 patient received previous radiotherapy. The median interval between the onset of cytotoxic treatment and the development of leukaemia was 27 months. The FAB M4 morphology was seen in 4 of 6 cases.
Conclusion:
The benefit of etoposide containing protocols outweigh the risk of leukaemia in patients with intermediate or high risk disease, however in patients with good risk disease non-etoposide containing protocols should be explored.
MeSH terms
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Acute Disease
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Adolescent
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Adult
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Antineoplastic Agents / adverse effects*
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Antineoplastic Agents / therapeutic use
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Antineoplastic Combined Chemotherapy Protocols*
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Bleomycin / administration & dosage
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Bleomycin / adverse effects
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Cohort Studies
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Cytarabine / administration & dosage
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Cytarabine / adverse effects
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Dactinomycin / administration & dosage
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Dactinomycin / adverse effects
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Dose-Response Relationship, Drug
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Etoposide / administration & dosage
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Etoposide / adverse effects*
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Germinoma / drug therapy*
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Humans
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Leukemia, Myeloid / chemically induced*
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Male
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Methotrexate / administration & dosage
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Methotrexate / adverse effects
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Middle Aged
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Neoplasms, Second Primary / chemically induced*
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Testicular Neoplasms / drug therapy*
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Vincristine / administration & dosage
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Vincristine / adverse effects
Substances
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Antineoplastic Agents
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Cytarabine
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Bleomycin
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Dactinomycin
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Vincristine
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Etoposide
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Cyclophosphamide
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Methotrexate