Carmustine as a Cause of Acute Nonlymphocytic Leukemia

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Abstract
To the Editor: We previously reported an increased risk of acute nonlymphocytic leukemia and preleukemia among patients receiving adjuvant chemotherapy with semustine for gastrointestinal cancer.1 Evidence that other nitrosoureas (e.g., carmustine, lomustine, and streptozocin) may be leukemogenic, however, has been confined to case reports2 3 4 or patients exposed to multiple agents.5 6 7 To obtain quantitative data, we conducted a follow-up study of patients enrolled in seven randomized clinical trials sponsored by the U.S. Brain Tumor Study Group (BTSG protocols 6601, 6901, 7201, 7501, 7701, 7702, and 8001), using techniques described previously.1 Treatment arms included surgery alone and surgery plus radiation, chemotherapy, or . . .