Editorial Comment To Therapy-Related Acute Myeloid Leukemia And Myelodysplastic Syndrome Among Refractory Germ Cell Tumor Patients

ObjectivesTo analyze cases of therapy-related acute myeloid leukemia and myelodysplastic syndrome diagnosed after chemotherapy for refractory testicular and extragonadal germ cell tumor in our experience.MethodsA total of 171 consecutive patients who were diagnosed and treated as refractory germ cell tumor and had records of detailed chemotherapy doses between April 1998 and December 2015 were retrospectively reviewed.ResultsFour testicular tumor patients (4/171, 2.3%) developed therapy-related acute myeloid leukemia and myelodysplastic syndrome. Three of them were affected after complete remission of the primary testicular tumor. A median time interval from a start of chemotherapy to a secondary tumor development was 6.8years (range 3.7-11.5years). The median total dose of etoposide, ifosfamide, cisplatin and nedaplatin were 3640mg/m(2) (range 2906-4000mg/m(2)), 42.7g (range 19.5-54.0g), 1100mg/m(2) (range 600-1500mg/m(2)) and 500mg/m(2) (range 300-1600mg/m(2)), respectively. Etoposide had the only significant relationship between a cumulative dose and leukemogenesis in univariate analysis (P<0.05). One patient had complete remission, but the other three patients died.ConclusionsThe present findings show that refractory germ cell tumor patientshave an increased risk of therapy-related acute myeloid leukemia and myelodysplastic syndrome. A cumulative dose of etoposide is a significant risk of leukemogenesis. As therapy-related acute myeloid leukemia and myelodysplastic syndrome has a poor prognosis, close follow up is required for refractory germ cell tumor patients.