Epipodophyllotoxin-related leukemia after Langerhans Cell Histiocytosis: A case report

N. El Banna, Z. Al-Lamki*, E. T. Smigura, Y. Wali, D. Dennison

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The spectrum of side effects induced by Etoposide (VP16) includes myelosuppression, nausea and vomiting, mucocutaneous effects, hepato-toxicity and rarely allergic reactions. Recent reports have documented acute myeloid leukemia (AML) following therapy with epipodophyllotoxins. We report a case of VP16 related AML in a child with Langerhans Cell Histiocytosis (LCH). She demonstrated a disease regression with VP16 at a cumulative dose of 6000 mg/m2 after having failed to respond to a multi-agent regimen containing prednisolone, vincristine, methotrexate and 6 Mercatopurine. At 3 1/2 years after starting treatment with VP16 she developed therapy-related leukemia; AML, M3 with t(15;17). The picture was similar to that reported by Haupt and co-workers in the Italian cohort study. Although VP16 is an effective treatment in multisystem disease we hereby further suggest that high total cumulative dose of over 4000 mg/m2 may increase the risk of abnormality on chromosome 15 and 17 with the resultant development of secondary acute promyelocytic Leukemia (APL). This observation applies not only to the Italian and Latino population but also to other ethnic groups such as two other cases reported by Horbe, K., Matsushita, T., Numata, S. et al. Cancer, 72(12), 3723-6 and our patient who is the only case report of an Arab origin. She attained remission with antileukemic therapy followed by a successful outcome from bone marrow transplantation (BMT).

Original languageEnglish
Pages (from-to)15-19
Number of pages5
JournalInternational Journal of Pediatric Hematology/Oncology
Issue number1
Publication statusPublished - 1999


  • Bone marrow transplantation (BMT)
  • High dose Etoposide (VP16)
  • Langerhans Cell Histiocytosis (LCH)
  • Therapy induced acute myeloid leukemia (t-AML)
  • Therapy related M with t(15; 17)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Cancer Research


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