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Essential thrombocythemia and leukemic transformation.

S M Sedlacek, J L Curtis, J Weintraub

    Medicine
    |November 1, 1986
    PubMed
    Summary
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    Treatment for essential thrombocythemia (ET) with alkylating agents or 32P may increase leukemia risk. Current practice of treating asymptomatic ET patients may not be justified due to this risk.

    Area of Science:

    • Hematology
    • Oncology
    • Medical Research

    Background:

    • Essential thrombocythemia (ET) is a myeloproliferative neoplasm.
    • Alkylating agents and phosphorus-32 (32P) are established treatments for ET.

    Observation:

    • Three cases of ET transforming into leukemia were observed within a four-month period.
    • Two patients treated with uracil mustard developed acute myelogenous leukemia and chronic myelomonocytic leukemia.
    • One patient treated with busulfan developed acute undifferentiated leukemia with myelofibrosis.

    Findings:

    • Review of literature identified 12 additional cases of ET with leukemic transformation, primarily linked to alkylating agents and/or 32P.
    • Leukemic transformation appears to be an unusual event in ET, particularly outside of chemotherapy exposure.

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  • One patient treated for asymptomatic ET with a high platelet count developed leukemia and died during chemotherapy.

    • Implications:

    • The natural history of ET may involve a risk of leukemic evolution, similar to polycythemia vera, especially after chemotherapy.
    • Treating asymptomatic ET patients with alkylating agents or 32P may warrant re-evaluation due to the increased risk of subsequent leukemia.
    • Findings suggest a need to weigh the benefits against the risks of chemotherapy in ET management, particularly for asymptomatic individuals.