Therapy-Related Acute Myelogenous Leukemia Associated with 11q23 Chromosomal Abnormalities and Topoisomerase II Inhibitors: Report of Four Additional Cases and Brief Commentary

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Abstract
We report 4 additional cases of therapy-related acute myelogenous leukemia (t-AML) with the translocation t(9;1 l)(p22q23). Chemotherapy for the primary malignancy (breast carcinoma in2, non-Hodgkin's lymphoma in 2) included agents with topoisomerase II inhibitory activity (doxorubicin in 2; doxorubicin and etoposide in 1; doxorubicin, etoposide and mi-toxantrone in l) as well as alkylators. In agreement with previous reports, the leukemia was monoblastic (FAB M5 subtype) in all 4 patients, with only 1 having prior myelodysplasia, and the latency period from primary therapy was relatively short (24–48 months). All patients received potentially curative treatment for the leukemia which included allogeneic bone marrow transplantation in 3; however, all died (3 of t-AML and l of lymphoma). Therapy-related AML associated with exposure to agents with topoisomerase II inhibitory activity (epipo-dophyllotoxins and anthracyclines) is a distinct entity, the genetic basis and optimal treatment of which remain to be determined.