Post-therapeutic acute malignant myeloproliferative syndrome and acute nonlymphocytic leukemia in non-Hodgkin's lymphoma correlation with intensity of treatment

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Abstract
In a prospective randomized study of treatment with radiation therapy (RT) or RT + chemotherapy (CT) for patients with non‐Hodgkin's lymphoma Stages I‐III, one patient developed an acute malignant myeloproliferative syndrome (AMSS) and four others acute nonlymphocytic leukemia (ANLL). There was correlation between the intensity of treatment and development of this complication: Among patients treated with local radiation with or without chemotherapy no cases of AMMS or ANLL were observed. However, patients treated with total lymphoid irradiation alone (TLI) had an observed to expected ratio of 162. Among patients treated with TLI plus CT this ratio increased to over 1000. The cytogenetic, clinical, and hematologic abnormalities of these patients are discussed.