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LEUKEMIA AFTER CHEMOTHERAPY FOR OVARIAN CANCER.

Although alkylating agents are known to be leukemogenic, the magnitude of their risk has not been well assessed. In this multicenter case-control study involving 99,113 survivors of ovarian cancer, Kaldor and colleagues matched each of the 114 patients who had leukemia to three who did not, to determine the leukemia risk associated with different cancer treatments.

Compared with surgery alone, chemotherapy alone was associated with a 12-fold higher relative risk of leukemia; the risk was greatest four to five years after chemotherapy began. Chlorambucil and melphalan were the most leukemogenic drugs. Radiotherapy alone did not significantly increase the risk of leukemia, compared with surgery alone. The risk of leukemia in patients who received both chemotherapy and radiotherapy was about the same as in patients given only chemotherapy. The combination of doxorubicin and cisplatin was also associated with an increased risk of leukemia -- a new observation.

The absolute risk of leukemia in patients receiving chemotherapy for ovarian cancer is small. However, the benefits from chemotherapy do not appear to be great. Moreover, the intensive, multiple drug regimens now commonly used for ovarian cancer seem most likely to raise the subsequent risk of leukemia. It is therefore not clear whether the benefits of such therapy outweigh the risks.

— ALK

Published in Journal Watch General Medicine January 12, 1990

Citation(s):

Kaldor JM et al. Leukemia following chemotherapy for ovarian cancer. N Engl J Med 1990 Jan 4 322 1-6.

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