Acute leukemia after cytotoxic treatment for nonmalignant disease in childhood. A case report and review of the literature.

The case history of an 11-year-old boy is reported. The child developed the nephrotic syndrome at the age of 17 months. He was treated with prednisolone, cyclophosphamide, cytosine-arabinoside and chlorambucil for the following three and a half years. Three and a half years after cessation of any medical treatment he developed anemia, thrombocytopenia and a diagnosis of acute lymphocytic leukemia (ALL) was made. Subsequently he responded to the West Berlin Protocol. Reviewing the literature, another eight cases of acute leukemia after cytotoxic treatment for nonmalignant disease in childhood have been reported. Most often the myeloblastic form of acute leukemia was diagnosed. Even though the pathogenic mechanism of acute leukemia after cytotoxic treatment is not known, the possibility must be considered that the incidence of this malignant disease is increased after cytotoxic treatment for nonmalignant diseases.