Astrocytoma as a second malignancy in patients with acute lymphoblastic leukemia

Three cases of astrocytoma, two cerebral (grades II and III) and one spinal (grade II) occurring as second malignancies in patients with previously diagnosed acute lymphoblastic leukemia are described. All had received prophylactic cranial irradiation and intrathecal methotrexate. All were in remission at the time of development of the second malignancy. The time interval between central nervous system (CNS) prophylaxis and symptoms of CNS tumor was between 3 and 5 years. The possible causes of the combination of astrocytoma with acute lymphoblastic leukemia are discussed.