Secondary myelodysplastic syndromes and acute leukemias.

Secondary myelodysplastic syndrome (sMDS) and secondary acute leukemia (sAL) are hematologic neoplasms occurring a few years following another primary malignancy, and are believed to be related to the chemotherapy used for the primary disease. Alkylating agents are considered to be more leukemogenic than other chemotherapeutic agents. Hodgkin's disease and multiple myeloma, among the hematologic neoplasms, and breast cancer among the solid tumors, are associated with this late complication more than other malignancies. The clinical picture is similar to primary MDS. However, the course is rapid, with early leukemic transformation and poor prognosis. since many sMDS patients are relatively young, it is reasonable to suggest an aggressive approach, i.e. bone-marrow transplantation (BMT) or antileukemic chemotherapy. The older patients may be offered low dose ara-c (LDAC), differentiating agents or clinical trials with growth factors. Even the responders survive no more than a few months.