Iatrogenic and idiopathic acute myelogenous leukemia: A comparison of clinical features and treatment complications

  • C. K. Oladipupo Williams
  • Janet Cuttner
  • Takao Ohnuma
  • Edward P. Ambinder
  • Paulo P. C. Ferreira
  • James F. Holland
Original Articles


We have compared the clinical and laboratory features as well as treatment complications observed in 6 patients with iatrogenic acute myelogenous leukemia (I-AML) with those of 26 patients with idiopathic acute myelogenous leukemia (AML). I-AML patients were significantly younger and their disease appeared less virulent on admission than in the AML patients. Following identical chemotherapy, hemorrhagic complications and the need for platelet support were found to be similar for both groups. Major infections, including systemic candidiases and Gram-negative septicemias, occurred 3 times more frequently among I-AML than AML patients. More marked suppression and delayed regeneration of the bone marrow also occurred in I-AML patients. These observations and other factors, such as post-splenectomy state and inherent immune deficiency among surgically staged lymphoma patients as well as radiation induced immunologic impairment, may have contributed to the increased propensity to develop infection observed in this group of patients. Five of the 6 I-AML and 17 of the 26 AML patients achieved remission. We attribute the satisfactory outcome in our I-AML patients to treatment in a protective environment and availability of facilities for hematologic supportive care.

Key words

Hematological supportive care Iatrogenic acute leukemia Infection complications Leukemia chemotherapy Infection in post-splenectomy state 


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  1. 1.
    Alavi J B, Root R K, Djerassi I, Evans A Eet al: Clinical trial of granulocyte for infection in acute leukemia.New Engl J Med 296, 706–711 (1977).PubMedGoogle Scholar
  2. 2.
    Arseneau J C, Sponso R W, Levin D L, Schnipper L E, Bonner H, Young R C, Canellos G P, Johnson R E, De Vita V T: Non-lymphomatous malignant tumours complicating Hodgkin’s disease. Possible association with intensive therapy.New Engl J Med 287, 1119–1122 (1972).PubMedGoogle Scholar
  3. 3.
    Bruckner H W, Cohen C J, Wallach R C, Kabakow B, Deppe G, Greenspan E M, Gusberg S B, Holland J F: Prospective controlled randomized trial comparing combination chemotherapy of advanced ovarian cancer with adriamycin,cis-platinum ± cyclophosphamide and Hexamethylmelamine.Proc Am Ass Cancer Res/Am Soc Clin Oncol 20, 414 (1979).Google Scholar
  4. 4.
    Cairns J W, Healy M J R, Stafford D M, Vitok P, Waters D A W: Evaluation of the Hemalog D differential leucocyte counter.J Clin Path 30, 997–1004 (1977).PubMedCrossRefGoogle Scholar
  5. 5.
    De Vita V T, Lewis B J, Rosenzweig M, Muggia F: The chemotherapy of Hodgkin’s disease. Past experiences and future directions.Cancer 42, Suppl. 2, 979–990 (1978).Google Scholar
  6. 5a.
    Greene M H, Boice J D, Greer B E, Blessing J A, Dembo A J: Acute nonlymphocytic leukemia after therapy with alkylating agents for ovarian cancer. A study of five randomized studies.New Engl J Med 307, 1416–1421 (1982).PubMedGoogle Scholar
  7. 6.
    Han T, Minowada J: Impairment of cell-mediated immunity of untreated Hodgkin’s disease: evaluation by skin test, lymphocyte stimulation tests, and T and B lymphocyte counts.NY State J Med 78, 216–221 (1978).Google Scholar
  8. 7.
    Herzig R H, Herzig G P, Graw R C (Jr), Bull M I, Ray K K: Successful granulocyte transfusion therapy for gramnegative septicemia. A prospective randomized controlled study.New Engl J Med 296, 701–705 (1977).PubMedGoogle Scholar
  9. 8.
    Higby D D, Yates J W, Henderson E S, Holland J F: Filtration leukapheresis for granulocyte transfusion therapy. Clinical and Laboratory Studies.New Engl J Med 292, 761–766 (1975).PubMedGoogle Scholar
  10. 9.
    Jacobs E M, Muggia F M, Rosenzweig M: Chemotherapy of testicular cancer: from palliation to curative adjuvant chemotherapy.Semin Oncol 6, 3–13 (1979).PubMedGoogle Scholar
  11. 10.
    Kohorn E T, Mitchell M S, Dwyer J M, Knowlton A H, Klein-Angerer S: Effect of radiation on cell-mediated cytotoxicity and lymphocyte populations in patients with ovarian carcinoma.Cancer 41, 1040–1048 (1978).PubMedCrossRefGoogle Scholar
  12. 11.
    Preisler H D, Bjonsson E: Protected environment units in the treatment of acute leukemia.Semin Oncol 2, 369–377 (1976).Google Scholar
  13. 12.
    Preisler H D, Lyman G H: Acute myelogenous leukemia subsequent to therapy for a different neoplasm: clinical features and response to therapy.Am J Hemat 3, 209–218 (1977).PubMedGoogle Scholar
  14. 12a.
    Preisler H H, Early A P, Raza A, Vlatides G, Marinello M J, Stein A M, Browman G: Therapy of secondary acute nonlymphocytic leukemia with cytarabine.New Engl J Med 308, 21–23, (1983).PubMedGoogle Scholar
  15. 13.
    Rajak R F, Nissen H I, Statzman L, Hoogstraten B, Cooper M R, Glowienka L P, Glidewell O, Glickman A, for Cancer and Leukemia Group B: Acute myeloid leukemia (AML) occurring during complete remission (CR) in Hodgkin’s disease.Proc Am Ass Clin Res/Am Soc Clin Oncol 20, 394 (1979).Google Scholar
  16. 14.
    Reimer R R, Hoover R, Fraumeni J F, Young R C: Acute leukemia after alkylating-agent therapy of ovarian cancer.New Engl J Med 297, 177–181 (1977).PubMedGoogle Scholar
  17. 15.
    Rodriquez V, Bodey G P, Freireich E J, McCredie F B, Gutterman J U, Keating M J, Smith T L, Gohan E A: Randomized trial of protected environment— prophylactic antibiotics in 145 adults with acute leukemia.Medicine (Baltimore)57(3), 253–266 (1978).Google Scholar
  18. 16.
    Rosner F, Gruenwald H for Acute Leukemia Group B: Hodgkin’s disease and acute leukemia.Am J Med 58, 339–353 (1975).PubMedCrossRefGoogle Scholar
  19. 17.
    Rowley J D, Golomb H M, Hardiman J: Acute leukemia after treatment of lymphoma (Letter).New Engl J Med 1013 (1977).Google Scholar
  20. 18.
    Simone J V, Aur R J A, Hustu H O, Verzosa M S, Pinkel D: Three to ten years after cessation of therapy in children with leukemia.Cancer 42 (Suppl. 2), 839–844 (1979).Google Scholar
  21. 19.
    Valagussa P, Kenda R, Bellani P F, Pranchi F, Banfi A, Rilko F, Bonadonna G: Incidence of second malignancies in Hodgkin’s disease (HD) after various forms of treatment.Am Soc Clin Oncol 20, 360 (1979).Google Scholar
  22. 20.
    Weiden P L, Lerner K G, Geddes A, Heywood J D, Fefer A, Thomas E D: Pancytopenia and leukemia in Hodgkin’s disease: report of three cases.Blood 42, 571–577 (1973).PubMedGoogle Scholar
  23. 21.
    Weitzman S A, Aisenberg A C, Siber G R, Smith D H: Impaired humoral immunity in treated Hodgkin’s disease.New Engl J Med 297, 245–248 (1977).PubMedGoogle Scholar
  24. 22.
    Yates J W, Holland J F: A controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients.Cancer 32, 1490–1498 (1973).PubMedCrossRefGoogle Scholar
  25. 23.
    Young R C, Cordor N P, Haynes H A: Delayed hypersensitivity in Hodgkin’s disease. A study of 103 untreated patients.Am J Med 52, 63–72 (1972).PubMedCrossRefGoogle Scholar
  26. 24.
    Zarrabi M N, Rosner F, Bonnett J M: Acute leukemia and non-Hodgkin’s lymphomas.New Engl J Med 298, 280 (1978).PubMedGoogle Scholar
  27. 25.
    Zarrabi M H, Rosner F: Acute myeloblastic leukemia following treatment for non-hematopoietic cancers: report of 19 cases and review of the literature.Am J Hemat 7, 357–367 (1979).PubMedCrossRefGoogle Scholar
  28. 26.
    Ziegler J L, Magrath I T, Olweny C L M: Cure of Burkitt’s lymphoma.Lancet ii, 936–938 (1979).CrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 1987

Authors and Affiliations

  • C. K. Oladipupo Williams
    • 1
  • Janet Cuttner
    • 1
  • Takao Ohnuma
    • 1
  • Edward P. Ambinder
    • 1
  • Paulo P. C. Ferreira
    • 1
  • James F. Holland
    • 1
  1. 1.Department of Neoplastic DiseasesMount Sinai School of Medicine and Medical CentreNew YorkUSA

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