[A case of secondary leukemia in anaplastic seminoma patient treated with long-term chemotherapy]

A 46-year-old man had received a long-term induction plus salvage chemotherapy for anaplastic seminoma with stage IV disease. Chemotherapy regimens and cycles included the following; four cycles of bleomycin plus vinblastine plus cisplatin (BVP); eight cycles of cyclophosphamide, vincristine, and cisplatin (COP); three cycles of etoposide plus cisplatin (EP); thirteen cycles of etoposide with ifosfamide and cisplatin (VIP). The total cumulative dose of etoposide was 4250 mg/m2. Severe and persistent pancytopenia developed 32 months after starting etoposide-based salvage chemotherapy. Bone marrow examination showed hypercellular marrow containing 68% myeloblasts but peroxidase reaction was negative. CD-13 was 30.1% which meant that leukemia was myelogenous. Therefore, he was diagnosed as acute myelogenous leukemia. French-American-British classification was MO. Chromosome analysis revealed a t (8; 21)(q22;q22) cytogenetic abnormality. This case may be compatible with the clinical and cytogenetic characters of epipodophyllotoxin-related leukemia. We conclude that high doses of etoposide seem to be leukemogenic. To our knowledge, this is the first reported case in the literature relevant to epipodophyllotoxin-related secondary leukemia in testicular tomor in Japan.