[Therapy-related acute leukaemia and myelodysplastic syndrome]

Secondary hematological malignancies represent a severe complication of cancer treatment. Their real incidence is unknown because of the heterogeneity of primary tumors, their therapies, and their prognosis. The usual presentation is an acute leukemia or myelodysplastic syndrome. Two different diseases have been described with particular clinical and cytogenetic features, namely the one associated with alkylating drugs and that related to epipodophylotoxins. Diagnosis is based on clinical suspicion, morphological alterations and cytogenetic studies. Prognosis is uniformly dismal. Conventional chemotherapy is mainly palliative, whereas allogenic transplantation allows the cure of a small percentage of cases. Thus, potential curative therapies for solid tumors should be optimized and patients maintained in long-term surveillance programs.