Therapy related acute myeloblastic leukemia following gestational trophoblastic tumor: Possible role of high cumulative dose of etoposide

ABSTRACT

The development of secondary acute myeloblastic leukemia [sAML] following chemotherapy of a gestational trophoblastic tumor [GTT] is rare. Alkylating drugs are known leukemogenic agents and epipodophyllotoxins have been implicated in the causation of a distinct subset of sAML. We report a case of s AML following treatment of a gestational trophoblastic tumor with multiagent chemotherapy including alkylating agents and a high dose of etoposide. The leukemia was characterized as myelomonocytic leukemia [FAB- M4] with a normal chromosomal pattern and without any preceding myelodysplastic phase. The leukemia developed 3 years and 6 months after the first etoposide exposure. Continuous exposure to etoposide following administration of other cytotoxic drugs including alkylating drugs may increase the risk of sAML