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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Rowe, J. M. Search for Related Content PubMed Articles by Rowe, J. M. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 July 2003, Vol. 102, No. 1, pp. 1 Secondary leukemia or unfavorable leukemia? Secondary leukemia usually describes a myeloid leukemia that follows treatment with chemotherapy or radiation or an exposure to any leukemogen. Smith and colleagues (page 43) describe a remarkable series, spanning 3 decades, of 306 consecutive patients with therapy-related myeloid leukemia. The majority of these patients had deletions in chromosomes 5 or 7 or t(11q23). These data have elegantly emphasized the predominant abnormalities in secondary leukemia and the expected latency period for each cytogenetic subtype. This paper confirms the poor prognosis for patients with secondary leukemia, revealing a dismal long-term outcome that is identical to acute myeloid leukemia (AML) patients with similar unfavorable cytogenetics who have not been previously exposed to leukemogens (Slovak et al, Blood. 2000;96:4075-4083). Other reports also indicate a similarity when known prognostic determinants such as morphology, immunophenotyping, and multidrug resistance (MDR) are considered (Leith et al, Blood. 1997;89:3323-3329). This raises several issues. First, does the diagnosis of secondary leukemia confer a worse prognosis other than being a surrogate for a particular cytogenetic subtype? Despite a recent analysis from the Medical Research Council (MRC) in Britain suggesting an independent poor prognosis for patients with therapy-related leukemia (Goldstone et al, ASH 44th annual meeting, abstract 322, Blood. 2002;100:88a), there is no convincing evidence that this is a true biologic phenomenon other than a poorer prognosis related to antecedent disease and prior therapy. Furthermore, several reports indicate that patients with more favorable cytogenetics who have secondary leukemias have a prognosis that is similar to patients with de novo AML, with the same balanced translocations. Second, there are no data that secondary leukemias respond better to any combination, during induction or post-remission therapy, than to the standard therapy offered to AML patients with similar cytogenetic and other biologic prognostic factors. We may all be better served by focusing exclusively on the biology of a particular leukemia rather than a further subcategorization based on previous events in a patient's history. Jacob M. Rowe Rambam Medical Center and Technion, Haifa, Israel CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Clinical-cytogenetic associations in 306 patients with therapy-related myelodysplasia and myeloid leukemia: the University of Chicago series Sonali M. Smith, Michelle M. Le Beau, Dezheng Huo, Theodore Karrison, Ronald M. Sobecks, John Anastasi, James W. Vardiman, Janet D. Rowley, and Richard A. Larson Blood 2003 102: 43-52. [Abstract] [Full Text] [PDF] This article has been cited by other articles: S A Burchill Micrometastases in neuroblastoma: are they clinically important? J. Clin. Pathol., January 1, 2004; 57(1): 14 - 20. [Abstract] [Full Text] [PDF] This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Rowe, J. M. Search for Related Content PubMed Articles by Rowe, J. M. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?

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