Risk of Leukemia Associated With the First Course of Cancer Treatment: An Analysis of the Surveillance, Epidemiology, and End Results Program Experience2

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Abstract
The risk of leukemia associated with the first course of cancer treatment was evaluated in over 440,000 patients diagnosed during 1973–80 (average follow-up = 1.91 yr) from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Although the reporting of the first course of therapy probably was incomplete, 34 acute nonlymphocytic leu-kemias (ANLL) developed compared with 7.6 expected among 70,674 patients known to receive initial chemotherapy [relative risk (RR)=4.5, 95% confidence interval (CI)=3.1–6.3]. Significant ANLL excesses were observed following chemotherapy for breast cancer (RR=8.1), ovarian cancer (RR=22.2), and multiple myeloma (RR=9.5). Patients initially treated with radiation (with no record of chemotherapy) also had a significantly increased ANLL risk; 45 leukemias occurred versus 17.9 expected (RR=2.5, 95% CI=1.8–3.4). In this group, excess ANLL were found following irradiation for uterine corpus cancer (RR=4.0). Kidney and renal pelvis cancer patients had a twofold leukemia risk (all types) that was unrelated to treatment (RR=2.2).