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SECOND PRIMARY MALIGNANT DISEASE (SPMD) IN CHILDREN DURING REMISSION OF ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

Of 104 children treated with ALL from August 1970 to December 1976, two developed second primary malignant disease. A four year old white child in complete remission of ALL for 3 years developed chronic myelogenous leukemia. (Hays, T., Hutter, J.J., Lanzkowsky, P., Shende, A. and Holton, C.P.: Abstract, Western Society for Pediatric Research, 1975). The other SPMD, malignant histiocytic lesions of bone, occurred during the early remission phase of ALL in a 4 year old child. Induction of remission of ALL was successfully attained and while in continuous remission 5 months after the initial diagnosis, he developed bone pain in the left leg and left eye and multiple lytic lesions of the orbit, femoral epiphyses, tibia, fibuia and vertebral bodies. Biopsies of these lesions revealed them to be malignant histiocytic in nature. During a 10 month follow-up, he remains in remission of ALL. It appears that patients with one primary malignant disease are apt to develop a SPMD and treatment of malignant disease in such patients might actually percipitate the SPMD due to the disruption of balance between the immunologic surveillance system and the oncogenlc agent and/or due to emergence of drug resistance.