Erythroleukemia and other hematologic complications of intensive therapy in long-term survivors of small cell lung cancer

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Abstract
Eight patients with small cell bronchogenic carcinoma treated with intensive combination chemotherapy, with and without radiotherapy, were followed for a minimum of 2 1/2 yr without relapse. One patient, after a prodrome of macrocytic sideroblastic anemia, leukopenia, and thrombocytopenia, experienced erythroleukemia 34 mo. after starting chemotherapy and cytogenetic studies revealed extensive chromosomal abnormalities. Another patient had persistent macrocytic anemia and pancytopenia 2 yr after cessation of therapy. The remaining 6 patients have normal peripheral blood smears and cell counts. A significant incidence of preleukemic syndromes and acute leukemia appearing as late complications in intensively treated small cell lung cancer patients requires confirmation in larger series of long-term survivors. Prospective determination of marrow karyotype abnormalities may help to identify patients at greatest risk for developing secondary leukemia.