Risk of leukaemia after chemotherapy in a case-control study in Moscow

In a case-control study of second primary cancers in Moscow, there were 165 cases and 294 controls, matched for site of first primary, duration of follow-up since first primary and relapse history. Of the cases, 18 were of acute, non-lymphocytic leukaemia (ANLL), with 39 matched controls. Risk of ANLL was assessed with respect to chemotherapy for the first primary tumour. The chemotherapeutic agents investigated were nitrogen mustard, cyclophosphamide, procarbazine, doxorubicin, bleomycin, vinblastine, vincristine, prednisone and combinations. Increased risks were associated with use of nitrogen mustard (odds ratio = 9.94, not significant), doxorubicin (odds ratio = 11.25, 0.1 > P > 0.05) and vincristine (odds ratio = 26.57, P < 0.05). Despite the small number of cases and potential confounding by other agents, these findings, together with those of previous studies, suggest that some non-alkylating agents may predispose to second malignancies.