Secondary Acute Myelogenous Leukemia in Patients with Retinoblastoma: Is Chemotherapy a Factor?

Presented in part at: American Academy of Ophthalmology Annual Meeting, November 2003, Anaheim, California.

Received 27 February 2006; accepted 27 March 2007.

Purpose

To describe a series of patients with secondary acute myelogenous leukemia (sAML) and retinoblastoma (RB).

Design

Retrospective observational cases series.

Participants

Ocular and pediatric oncologists at referral centers in Europe and the Americas and the RB databases at the National Institutes of Health and the Ophthalmic Oncology Service at Memorial Sloan-Kettering Cancer Center.

Methods

Physician survey, retrospective database review, and literature search.

Main Outcome Measures

History of RB and development of sAML, management of RB (surgery, radiotherapy, chemotherapy), age at diagnosis of RB and leukemia, French-American-British (FAB) subtype, and current status of patient (alive or dead).

Results

Fifteen patients with sAML were identified; 13 occurred in childhood. Mean latent period from RB to AML diagnosis was 9.8 years (median, 42 months). Nine cases were of the M2 or M5 FAB subtypes. Twelve patients (79 %) had received chemotherapy with a topoisomerase II inhibitor, 8 (43%) had received chemotherapy with an epipodophyllotoxin. Ten children died of their leukemia.

Conclusions

Acute myelogenous leukemia is a rare secondary malignancy among retinoblastoma patients, many of whom were treated with primary or adjuvant chemotherapy. Additional studies are needed to assess potential risk factors contributing to sAML development in this cohort.

1 Section of Ophthalmology, Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.

2 Ocular Oncology Service, Barts and the London National Health Service Trust, London, United Kingdom.

3 Ocular Oncology Service, Moorfields Eye Hospital. London, United Kingdom.

4 Ophthalmic & Pediatric Oncology, Memorial Sloan–Kettering Cancer Center, New York, New York.

5 Hospital JP Garrhan, Buenos Aires, Argentina.

6 Department of Pediatrics, Cancer Hospital São Paulo, São Paulo, Brazil.

7 Department of Ophthalmology, University of Chicago, Chicago, Illinois.

8 Department of Ophthalmology, University of Tennessee Health Science Center, and Division of Ophthalmology, Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee.

9 Pediatric National Institute, Mexico City, Mexico.

10 Oncology Department, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.

11 Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, Miami, Florida.

12 Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

13 Department of Pediatric Oncology and Hematology, University of Essen, Essen, Germany.

14 Department of Ophthalmology, University of Essen, Essen, Germany.

15 Chinese University of Hong Kong, Hong Kong, China.

Correspondence to Dan S. Gombos, MD, FACS, Section of Ophthalmology, Department of Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 441, Houston, TX 77030.

Manuscript no. 2006-247.

PII: S0161-6420(07)00377-6

doi:10.1016/j.ophtha.2007.03.074

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