Second malignancy in acute lymphocytic leukemia. Review of 33 cases.

Improved survival in childhood cancer resulting from advances in therapy is frequently associated with long-term morbidity, including the potential for second malignancy. In a review of the literature in the English language, we found 33 cases of acute lymphocytic leukemia (ALL) followed by a second neoplasm. Second tumors in this group of patients with ALL include seven cases of histiocytic medullary reticulosis, four cases of Hodgkin's disease, nine cases of acute myelocytic leukemia, four cases of chronic myelocytic leukemia, and nine cases of solid tumors. The appearance of subsequent malignancies may be related to a combination of therapy-induced immunosuppression, a direct carcinogenic effect resulting from therapy, and/or constitutional factors. Physicians should be alert to the possibility of subsequent malignant neoplasms in survivors of cancer.