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Secondary Leukemia After Chemotherapy and/or Radiotherapy for Gynecologic Neoplasia

Shimada, Takako MD, PhD*; Saito, Toshiaki MD, PhD*; Okadome, Masao MD*; Shimamoto, Kumi MD*; Ariyoshi, Kazuya MD, PhD*; Eto, Takako MD*; Tomita, Yui MD; Kodama, Keisuke MD

International Journal of Gynecological Cancer: February 2014 - Volume 24 - Issue 2 - p 178–183
doi: 10.1097/IGC.0000000000000045
Review Article

Objective Secondary leukemia is a known complication of chemotherapy and radiotherapy. It was generally recognized that leukemia secondary to chemotherapy was due to the use of alkylating agents in the treatment of ovarian cancer. Recently, many types of chemotherapeutic agents have been used in the treatment of gynecologic malignancies in addition to ovarian cancer. We analyzed the clinical characteristics and outcome of patients with recent onset of secondary leukemia after the treatment of gynecologic cancer to consider the diagnosis and management of secondary leukemia.

Materials and Methods We reviewed the clinical charts and follow-up data of patients with gynecologic malignancies treated in the past 20 years. During this period, 2482 newly diagnosed invasive gynecologic cancers were treated in our institution. All patients with secondary leukemia were analyzed for clinical background, latency period (interval between the diagnosis of primary carcinoma and the development of leukemia), treatment, and outcome. We also reviewed the literature for secondary leukemia under gynecology using the PubMed.

Results Four patients were found to have developed secondary leukemia after the treatment of gynecologic malignancies during this period. The cumulative risk of secondary leukemia was approximately 0.38%. All patients received platinum-based chemotherapy. Two patients received combination chemotherapy and/or bone marrow transplantation, and 1 of these 2 patients lived more than 6 years but died of recurrent ovarian cancer.

Conclusions Long survival time might be expected in patients who show complete response to bone marrow transplantation and/or combination chemotherapy for secondary leukemia. In recent years, we have aggressively used various types of anticancer drugs for the treatment of not only ovarian cancer but also uterine cervical cancer and endometrial cancer. Physicians need to keep in mind the risk of secondary leukemia in the follow-up of long-term survivors after several courses of chemotherapy and radiotherapy.

*Gynecology Service, National Kyushu Cancer Center; and †Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan.

Address correspondence and reprint requests to Toshiaki Saito MD, PhD, Gynecology Service, National Kyushu Cancer Center, 3-1-1 Notame, Fukuoka 811-1347, Japan. E-mail:

The authors declare no conflicts of interest.

Received September 11, 2013

Received in revised form October 22, 2013

Accepted October 22, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.