LEUKEMIA FOLLOWING CHEMOTHERAPY FOR OVARIAN-CANCER
LEUKEMIA FOLLOWING CHEMOTHERAPY FOR OVARIAN-CANCER
复制标题
DOI：
10.1056/nejm199001043220101
复制
发表时间：
1990-01-04
影响因子：
158.5
通讯作者：
STOVALL, M
中科院分区：
文献类型：
--
作者：
KALDOR, JM;DAY, NE;STOVALL, M
一个由癌症登记处和医院组成的国际合作小组确定了114例卵巢癌后白血病病例。我们采用病例对照研究设计，调查了化疗、放疗和其他因素可能的病因学作用，每个白血病病例有三个对照。与单纯手术相比，单纯化疗的相对风险为12（95%置信区间，4.4 - 32），同时接受化疗和放疗的患者的相对风险为10（95%置信区间，3.4 - 28）。与单独手术相比，单独放疗并不会显着增加风险。白血病的风险在化疗开始后的四到五年内最高，并且在化疗停止后至少八年内风险升高。环磷酰胺、苯丁酸氮芥、美法仑、噻替派和曲奥舒凡与白血病风险显著增加独立相关，盐酸多柔比星和顺铂联合用药也是如此。苯丁酸氮芥和美法仑是致白血病作用最强的药物，其次是塞替派;环磷酰胺和曲奥舒凡是致白血病作用最弱的药物，高剂量时每克的作用大大低于低剂量。白血病的相对风险在多大程度上被化疗有效性的差异所抵消尚不清楚。
An international collaborative group of cancer registries and hospitals identified 114 cases of leukemia following ovarian cancer. We investigated the possible etiologic role of chemotherapy, radiotherapy, and other factors, using a case-control study design, with three controls matched to each case of leukemia. Chemotherapy alone was associated with a relative risk of 12 (95 percent confidence interval, 4.4 to 32), as compared with surgery alone, and patients treated with both chemotherapy and radiotherapy had a relative risk of 10 (95 percent confidence interval, 3.4 to 28). Radiotherapy alone did not produce a significant increase in risk, as compared with surgery alone. The risk of leukemia was greatest four or five years after chemotherapy began, and the risk was elevated for at least eight years after the cessation of chemotherapy. The drugs cyclophosphamide, chlorambucil, melphalan, thiotepa, and treosulfan were independently associated with significantly increased risks of leukemia, as was the combination of doxorubicin hydrochloride and cisplatin. Chlorambucil and melphalan were the most leukemogenic drugs, followed by thiotepa; cyclophosphamide and treosulfan were the weakest leukemogens, and the effect per gram was substantially lower at high doses than at lower doses. The extent to which the relative risks of leukemia are offset by differences in chemotherapeutic effectiveness is not known.