Acute Erythroblastic Leukemia Terminating a Very Long-Lasting (27 Years) Hodgkin’s Disease

G. Mantovani, G.S. Del Giacco, F. Marongiu, S. Tognella, U.E. Carcassi Department of Clinical Medicine I, University of Cagliari Medical School, Via S. Giorgio 12, 1-09100 Cagliari (Italy) To the Editor, Although there is already an ample literature on acute leukemias, usually of myeloid type, complicating treated Hodgkin’s disease(HD), the case we present here seems to us very unusual both for the very long-lasting HD (27 years after the diagnosis) and for the arising of an acute erythroblastic leukemia (AEL), rare as a primary disease and even more so as a terminating event in HD, the only recent case reported being that of Larsen and Brincker [4]. The patient (a white woman, M.M.), who died at the age of 49, had the onset of the disease at the age of 22 (laterocervical lymph node involvement). The probable clinical stage at the time was II A. For the first 6 years of her disease the patient was given local radiotherapy of the regions involved (laterocervical, axillary, mediastinal) with regression of the involvement but with subsequent local and distant relapse. Then for about 4 years no relapses of the disease were evident. For the 3 following years she was again treated with radiation therapy and, for the appearance of general signs (fever), with chemotherapy (cyclophospha-mide, 3 g). In 1971, being 39, the patient was first seen by our group. She did not show superficial but lumbar and paraaortic lymph node involvement so that a stage III A was stated: a MOPP combination chemotherapy was started [3] and two cycles were administered but the therapy had to be discontinued owing to an acute hepatitis B. At the recovery from hepatitis complete remission of HD was achieved and the MOPP treatment was stopped. In 1976 (44 years) another lymphography demonstrated a lymph node involvement below the diaphragm. Histological examination during Iapa-rotomic staging suggested a moderate involvement of the spleen; moreover from a gastrointestinal X-ray with a barium meal the suspicion arose of a gastric involvement as well. The MOPP chemotherapy was restarted: 6 cycles were fulfilled and 5 additional cycles were administered as a maintenance therapy achieving again complete remission (even gastrointestinal X-rays with a barium meal and enema were negative). For the following 2 years (1979-1980) no treatment was given. In January 1981 the patient was hospitalized again: she complained of progressive pallor, mild fever, headache, weakness which had started 1 month before. The general state was seriously