Leukemogenesis related to chemotherapy of ovarian carcinoma: a review with three new case reports

A review of the literature of 68 case reports of acute leukemia following ovarian cancer is presented and 3 new cases are reported. Review of the literature revealed 34 patients received chemotherapy and radiotherapy, 32 patients received chemotherapy alone, 1 patient had only surgery, and the radiation status of the remaining patient is unclear. Chemotherapy usually consisted of alkylating agents often given in high dose and for long durations. The reported risk for developing acute leukemia after treatment of ovarian cancer ranges from 21 to 175 times that of the general population with a prevalence range in treated patients of 0.8 to 2.7%. The median interval from initiation of therapy to the development of leukemia is shortened from 54.2 to 41.1 months if radiation therapy is used in addition to chemotherapy. The patients typically exhibit a brief preleukemic phase and poor survival with death occurring 3 to 5 months after diagnosis of leukemia. Proposed mechanisms for leukemogenesis are presented.