Acute leukemia and immunosupressive drug use: a review of patients undergoing immunosuppressive therapy for non-neoplastic diseases

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Abstract
Reported cases (61) of acute leukemia developing in patients who previously received immunosuppressive agents for non-neoplastic disorders are reviewed. In 3 patients the diagnosis of acute leukemia was made less than 6 mo. after the 1st exposure to immunosuppressive drugs and was considered coincidental. Among the remaining 58 patients, most diagnoses were of myeloblastic or myelomonocytic leukemia. The underlying diagnoses in most of the 58 patients were rheumatoid arthritis or renal disease or renal transplant. Patients (30) received alkylating agents exclusively, 10 had received antimetabolites only, while the remaining 18 patients received multiple therapeutic modalities including antimetabolites, alkylating agents and/or radiation. Most patients also received large amounts of corticosteroids. Without considering the overall denominator of population at risk, the relatively high proportion of patients who received alkylating agents before developing acute leukemia suggests a causal relationship. This should be considered before using such drugs in non-life-threatening diseases.