Hans W. Grünwald

Second neoplasms in acute lymphoblastic leukemia

The authors reviewed 61 reported cases of second neoplasms in acute lymphoblastic leukemia (ALL), including 17 patients with ALL followed by another type of acute leukemia, 12 patients with ALL followed by chronic myelocytic leukemia, 19 patients with ALL followed by lymphoma, and 13 patients with ALL followed by other solid tumors. From a review of the literature, it is believed that there is no firm evidence yet that patients with ALL, intensively treated with chemotherapy and/or radiotherapy, are at increased risk of developing therapy‐related second neoplasms. Because the number of cases reported is small, there is even insufficient data to firmly suggest that acute myeloblastic leukemia, following intensive therapy for ALL, occurs in a higher‐than‐expected frequency.

A new effective four-drug combination of CCNU (1-[2-chloroethyl]-3-cyclohexyl-1-nitrosourea) (NSC-79038), vinblastine, prednisone, and procarbazine for the treatment of advanced Hodgkin's disease

Five hundred and sixty‐six patients with either Stage III or IV Hodgkins disease were prospectively randomized to test whether CCNU and/or vinblastine are more effective than mechlorethamine and/or vincristine with procarbarine and prednisone. The combination of CCNU, vinblastine, procarbazine, and prednisone (CVPP) was shown to be a highly effective program with a complete response frequency of 69%. The use of CCNU as part of the induction program was also shown to be the most significant determinant of prolonged remissions (P = .025). Reduced vomiting and neurotoxicity, as well as the oral administration, were the chief advantages of the CVPP as compared with MOPP. These factors resulted in improved patient and physician compliance. The MVPP regimen was also shown to be a highly effective regimen with a complete response frequency of 73% in patients without prior exposure to chemotherapy. However, the induction regimens containing vinblastine were associated with a significantly higher frequency of fatal hematopoietic toxicities than the induction regimens containing vincristine (P = .05). This higher frequency was almost exclusively seen in the elderly or in patients previously treated with both chemotherapy and radiotherapy. At this time, the remission durations maintained by vinblastine with periodic reinforcement are longer when compared with vinblastine maintenance alone (P = .06), but there is no corresponding increase in survival.

Simultaneous occurrence of multiple myeloma and acute myeloblastic leukemia: fact or myth?

A careful search of the literature disclosed 22 cases of the simultaneous occurrence of multiple myeloma and acute leukemia. An additional eight cases of macroglobulinemia and acute leukemia have also been described. Critical review of these reports, however, suggests that the concomitant occurrence of myeloma or Waldenströms macroglobulinemia and acute myeloblastic leukemia is quite uncommon and probably represents a coincidental or chance association.

Association of T cell acute lymphoblastic leukemia and histiocytic medullary reticulosis

Seventeen reported cases of acute lymphoblastic leukemia that terminated in a clinical picture of histiocytic medullary reticulosis were reviewed. Using the presence of T cell markers, mediastinal mass, or very high initial white blood cell count as suggestive of T cell acute lymphoblastic leukemia, nine of 13 evaluable cases fulfilled such criteria. This review raises the possibility that the histiocytic medullary reticulosis appearing in the course of T cell acute lymphoblastic leukemia is the result of lymphokine production by the leukemic cells.

Acute leukemia as a complication of cytotoxic chemotherapy

Abstract Acute leukemia occurring after intensive cytotoxic chemotherapy and/or radiotherapy has been reported in 122 patients with multiple myeloma, in 93 patients with Hodgkins disease, in 78 patients with breast cancer, in 45 patients with non-Hodgkins lymphoma, in 41 patients with chronic lymphotic leukemia and in 61 patients receiving immunosuppressive chemotherapy for a variety of non-neoplastic diseases. Although risk estimates have been calculated for several large series of patients (approximately 1% to 3% in several series), the precise carcinogenic or leukemogenic potential of cancer chemotherapeutic agents singly and in combinations is not known.

Benzene and Leukemia: What Are the Risks and What Do the Data Reveal?

Although benzene exposure is recognized as a risk factor for leukemia, there is still no universal consensus regarding which leukemias and what degree of exposure. Definition of benzene-associated leukemia has become more specific as the classification of leukemias is better understood. Review of the studies of benzene-exposed workers finds the excess of leukemia to be generally limited to acute myelogenous leukemia and its variants. Exposure assessment in these analyses has also become more sophisticated. The earliest risk assessments assumed that past exposures were at the legal limit; later analyses considered the exposure data available at the worksite studied. The most recent analyses have focused on the lifetime benzene exposure history of the employees studied, extending beyond the exposure at the studied worksite. Sub-analyses suggest that critical factors included level of exposure, rather than just cumulative exposure. The quality of risk analysis is enhanced when more complete information on exposure is included.