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Revision of the risk of secondary leukaemia after mitoxantrone in multiple sclerosis populations is required

Department of Neurology, Hospital Universitario La Fe, Spain, med004201saludalia.com

Neus Téllez

Department of Neurology, Hospital Vall d'Hebrón, d Spain

Isabel Boscá

Department of Neurology, Hospital Universitario La Fe, Spain

Javier Mallada

Department of Neurology, Hospital de Elda, Spain

Antonio Belenguer

Department of Neurology, Hospital General de Castellón, Spain

Inmaculada Abellán

Department of Neurology, Hospital de la Villajollosa, Spain

Angel P Sempere

Department of Neurology, Hospital General de Alicante, Spain

Pascual Fernández

Department of Haematology, Hospital General de Alicante, Spain

Ma José Magraner

Department of Neurology, Hospital Universitario La Fe, Spain

Francisco Coret

Department of Neurology, Hospital Clínico, Spain

Miguel A Sanz

Department of Haematology, Hospital Universitario La Fe, Spain

Xavier Montalbán

Department of Neurology, Hospital Vall d'Hebrón, d Spain

Bonaventura Casanova

Department of Neurology, Hospital Universitario La Fe, Spain

The objective in this paper is to compare the cumulative incidence and incidence density of therapy-related acute myeloid leukaemia in two cohorts of patients with multiple sclerosis treated with mitoxantrone, and with previously reported data in the literature. Six new cases of acute myeloid leukaemia were observed by prospectively following two Spanish series of 142 and 88 patients with worsening relapsing multiple sclerosis and secondary-progressive disease treated with mitoxantrone. A literature review shows 32 further cases of acute myeloid leukaemia reported, 65.6% of which are therapy-related acute promyelocytic leukaemia. Five cases in the cohorts fulfilled the diagnostic criteria for acute promyelocytic leukaemia, and one patient was diagnosed with pre-B-acute lymphoblastic leukaemia. Acute myeloid leukaemia latency after mitoxantrone discontinuation was 1 to 45 months. The accumulated incidence and incidence density was 2.82% and 0.62%, respectively, in the Valencian cohort, and 2.27% and 0.44% in the Catalonian cohort. In the only seven previously reported series, the accumulated incidence varied from 0.15% to 0.80%. The real incidence of acute myeloid leukaemia after mitoxantrone therapy in the multiple sclerosis population could be higher as evidenced by the growing number of cases reported. Haematological monitoring should continue for at least 5 years after the last dose of mitoxantrone. These data stress the necessity of re-evaluating this risk.

Key Words: chemotherapy • haematological study • incidence study • mitoxantrone • multiple sclerosis • secondary leukaemia

This version was published on November 1, 2009

Multiple Sclerosis, Vol. 15, No. 11, 1303-1310 (2009)
DOI: 10.1177/1352458509107015


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