Leukemia following treatment of germ cell tumors in men.

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Abstract
The incidence of leukemia occurring subsequent to the treatment of germ cell tumors was investigated in men over a 30-yr interval and 4 patients with acute nonlymphocytic leukemia (ANLL) and 1 patient with chronic myelomonocytic leukemia were found. The relative risk (observed/expected cases) estimates for the development of leukemia ranged from 13.7 (P = 0.0005) in the total population to 50.1 (P = 0.0001) in the group treated with cytotoxic agent alone. All 3 patients with ANLL treated with contemporary antileukemic therapy [6-mercaptopurine, corticosteriod, cytosine arabinoside, vinblastine, actinomycin D, bleomycin, cyclophosphamide, cisplatin, chlorambucil, thioguanine and methotrexate] had complete responses, with survivals of 7, 29, and 133+ mo. In a review of the literature, 14 additional cases of germ cell tumors were found in which the men subsequently developed leukemia. Leukemia following germ cell tumors is increased in incidence and is likely to be treatment induced. Complete responses and long-term survival are possible in secondary leukemia and aggressive antileukemic therapy should be given.