Therapy-related acute myeloid leukemia and myelodysplasia after successful treatment of acute promyelocytic leukemia.

The incidence of therapy-related myelodysplasia (t-MDS) and therapy-related acute myeloid leukemia (t-AML). following a high-dose chemotherapy for a prior cancer, is progressively increasing. Here we review patients treated by conventional therapy for acute promyelocytic leukemia (APL) who developed a t-MDS or t-AML in the course of their disease. This risk appears to be low, as only 12 unquestionable cases have been reported so far in the literature. Alkylating agents and etoposide are two major agents able to induce t-MDS or t-AML. However, some cases ask the question of the leukemic potential of other drugs, especially anthracyclines. The median latent period from achievement of complete remission (CR) of APL to diagnosis of t-MDS or t-AML was 34 (25-40) months. All patients presented chromosome abnormalities, mostly deletions or loss of the long arm of chromosome 5 and/or 7, or balanced translocations involving the 21q22 band. Prognosis is poor with a median of survival of 10 (7-22) months.