P43. Therapy-related leukemia after lung cancer therapy

Background: Therapy-related leukemia defined by the World health Organization 2008 classification scheme of hematolymphoid tumors including therapy-related acute myeloid neoplasms (t-AML), myelodysplastic syndrome (t-MDS). They occur as late complication of cytotoxic chemotherapy, radiation therapy and molecular target agents therapy against primary neoplasms. Recently, for lung cancer chemotherapy, new anti-cancer agent and molecular target agents are increased and more intensification chemotherapy performed. We report that we reviewed t-AML cases who survived from lung cancer and suffered t-AML.

Methods: We intended for multiple neoplasms 298 cases including hematological malignancy. We reviewed 39 multiple neoplasms including the lung cancer. In 39 cases, second neoplasms that were acute myeloid leukemia cases were two cases. All patients were followed up until death or until December 2013. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. We investigated cytogenetic abnormality, therapy, clinical outcome, prognosis, and cause of death.

Results: There were four cases multiple neoplasms including lung cancer and acute myeloid leukemia. In four cases, metachronous type and primary neoplasms that were lung cancer were two cases. These two cases were diagnosed therapy-related leukemia by WHO 2008 classification. Two of cases were male and female one respectively, primarily diagnosis were small cell carcinoma (male case), squamous carcinoma (female case). Previous cases, he treated operation and radiotherapy, another cases treated operation and chemotherapy that included cisplatin and camptotecin. One case (male case) was acute promyelocytic leukemia (t-APL) that had t(15;17) and PMLRARα, another case (female case) was M2 type (French-American-British Classification) that indicated t(8;21) abnormality. About t-APL, he treated by all-trans retinoic acid and he reached complete response. T-M2 type, he treated by chemotherapy included daunorbicin and Ara-C(DC3-7), she did not achieve complete response. About prognosis, t-APL case, he lived 1 month after complete response, he died by lung cancer, t-AML cases, she lived 25 months after partial response, she died by t-AML relapse and refractory for salvage chemotherapy.

Conclusions:As the number of lung cancer survivors increased due to improvement in chemotherapy, clinician must more take attention of therapy-related leukemia and myelodysplastic syndrome by previous treatments.

Keywords: Lung cancer; leukemia