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Alfred I. Neugut, MD, PhD; Eliezer Robinson, MD; Jeri Nieves, MS; Todd Murray; Wei-Yann Tsai, PhD

JAMA. 1990;264(8):1006-1008.

Abstract
Population-based data on more than 1 million patients registered in the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute, 1973 to 1984, were analyzed to determine the survival of patients with de novo acute nonlymphocytic leukemia (ANLL) and following a first primary tumor treated (with chemotherapy and/or radiation therapy) or untreated. Cases that occurred within 12 months of the first malignant neoplasm were excluded. Survival was estimated using Cox proportional-hazards modeling, with age, sex, and specific type of ANLL as covariates. The 6271 patients with de novo ANLL had an estimated 12-month survival of 30%, while the 107 patients with treatment-related ANLL (radiation therapy, 60; chemotherapy, 29; both, 18) had an estimated 12-month survival of 10%. This is not due to lingering effects of the first tumor since ANLL following solid tumors not treated with chemotherapy or radiation therapy (118 cases) has similar survival (estimated 12-month survival, 36%) as de novo ANLL. We conclude that ANLL that occurs after chemotherapy or radiation therapy is biologically more aggressive and/or resistant to therapy than spontaneous ANLL. This provides a rationale for current studies on treatment-induced cellular changes and on more aggressive therapy for these patients.

(JAMA. 1990;264:1006-1008)

Author Affiliations
From the Department of Medicine (Dr Neugut) and the School of Public Health (Drs Neugut and Tsai and Ms Nieves and Mr Murray), College of Physicians and Surgeons, Columbia University, New York, NY; and Northern Israel Oncology Center, Rambam Medical Center, and Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel (Dr Robinson).

Footnotes
Presented in part at the 25th Annual Meeting of the American Society for Clinical Oncology, San Francisco, Calif, May 21, 1989.

Reprint requests to Division of Oncology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032 (Dr Neugut).

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