Acute leukemia as a delayed consequence of cancer chemotherapy
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Abstract:
Acute myelocytic leukemia occurring many years after intensive radiotherapy and/or chemotherapy has been reported in 82 patients with Hodgkin's disease, 58 patients with multiple myeloma, and 40 patients with chronic lymphocytic leukemia. The precise incidence of this occurrence is uncertain, since the total number of patients at risk is unknown. Most patients with Hodgkin's disease had received intensive radiation therapy. Many also received chemotherapy. One-third of the patients with myeloma were treated only with melphalan. Acute leukemia may occur as part of the natural history of Hodgkin's disease and multiple myeloma; it has been seen with increasing frequency in recent years due to improved survival secondary to better treatment. It is also possible that radiotherapy and/or chemotherapy may be causally related to the development of acute leukemia.Keywords:
Melphalan
Objective:To evaluate the changes in levels of IL-6 and TNF-α in patients with acute leukemia before and after chemotherapy.Methods: The levels of IL-6 and TNF-α before and after chemotherapy in 30 patients with acute leukemia were detected with bioactivity assessment method.Results:The levels of IL-6 activity in patients with acute leukemia before chemotherapy were significantly higher than that of normal control group(P0.05),and after chemotherapy the levels of IL-6 in patients were much lower than that of normal control group(P0.05),also distinctly lower than those before chemotherapy(P0.05).The levels of TNF-α activity in patients with acute leukemia were significantly lower than that of normal control group(P0.05),after chemotherapy they were distinctly higher than those before chemotherapy(P0.05), also higher than that of normal control group(P0.05).Conclusion: Both IL-6 and TNF-α take part in the process of acute leukemia.
Clinical Significance
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High-dose chemotherapy with autologous peripheral blood stem cell transplantation was administered to five patients with refractory myeloma. To collect peripheral blood stem cells, apheresis was done by administering doxorubicin 40 mg/m2 on the first day, and etoposide 60 mg/m2 on the first, second, and third days, followed by G-CSF administration to harvest cells. The high-dose chemotherapy consisted of melphalan 60 mg/m2 administered for 4 days and infusion of mononuclear cells. No serious side effects were observed during the clinical course. After transplantation, complete or partial responses were achieved. APBSCT is considered to be a useful method because it had an antitumor effect against multiple myeloma that is refractory to conventional chemotherapy, as well as against multiple myeloma that is sensitive to chemotherapy, and it can be safely performed.
Melphalan
Refractory (planetary science)
Autologous stem-cell transplantation
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In a phase II study 28 patients with advanced multiple myeloma were treated with a five drug regimen consisting of vincristine, BCNU, adriamycin, melphalan and dexamethasone. 11 out of 13 patients without prior chemotherapy showed significant remissions (> 25% tumor cell mass reduction), 7 of them had more than 75% TCM reduction. Out of 15 additional patients resistant to previous chemotherapy, 13 had significant remissions, including 9 patients with > 75% TCM reduction. No tumor progression was observed in either group of patients. The median follow‐up of all patients was 12.75 months. 4 patients relapsed. Toxicity mainly related to the bone marrow was observed in 14 patients. This regimen might offer a promising alternative for the treatment of advanced multiple myeloma, but still has to be tested in a prospective randomized trial.
Melphalan
Regimen
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Acute myeloblastic leukemia
Chronic leukemia
Acute lymphocytic leukemia
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Objective: To investigate the effect of nursing measures to prevent infection during different phrases of chemotherapy in leukemia cases. Method: The leukemia patients is randomly separated into two groups, the experimental group was given nursing measures to prevent infection 3～7 days before chemotherapy,and the controled group was given after chemotherapy.Observe the infection incidence between the two groups. Result: The infection incidence of experimental group is lower than that of controled group. Conclusion: Taking nursing measures to prevent infection before chemotherapy in leukemia might help to reduce the infection incidence.
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ABSTRACT. Five patients with multiple myeloma ending in acute leukemia are described. The preleukemic phase was characterized by anemia, leukopenia and/or thrombocytopenia. The incidence of acute leukemia in myeloma was calculated to be 6%. Melphalan therapy for more than two years increased the incidence to 14%. All patients who developed leukemia had received a total melphalan dose of at least 1100 mg.
Melphalan
Leukopenia
Plasma cell leukemia
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Rapidly fatal acute myelomonocytic leukemia developed in five patients with multiple myeloma who were treated with melphalan for 28 to 54 months. In each patient, multiple myeloma responded to therapy and progress was satisfactory until the development of acute leukemia. At postmortem examination, leukemic infiltration of organs was seen, and there was little or no evidence of myeloma. Consideration of these cases and a review of the literature suggest that these circumstances represent the development of acute myelomonocytic leukemia rather than plasma cell leukemia; there also appears to be an increased incidence of acute leukemia in multiple myeloma, probably related to the alkylating agent.
Acute myelomonocytic leukemia
Melphalan
Plasma cell leukemia
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Rapidly fatal acute myelomonocytic leukemia developed in five patients with multiple myeloma who were treated with melphalan for 28 to 54 months. In each patient, multiple myeloma responded to therapy and progress was satisfactory until the development of acute leukemia. At postmortem examination, leukemic infiltration of organs was seen, and there was little or no evidence of myeloma. Consideration of these cases and a review of the literature suggest that these circumstances represent the development of acute myelomonocytic leukemia rather than plasma cell leukemia; there also appears to be an increased incidence of acute leukemia in multiple myeloma, probably related to the alkylating agent.
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A 40-year-old man who developed acute myelomonoblastic leukemia (M4) after 7 years of treatment for multiple myeloma with the alkylating agent melphalan and steroids is presented. Leukemia was treated with courses of adriblastin, cytosine arabinoside, and thioguanin (DAT protocol), with a 8 months' survival.
Melphalan
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