A 26-year-old man developed myelodysplasia rapidly progressing to acute myelomonocytic leukemia 3 years after receiving three cycles of ABVD chemotherapy and upper mantle and upper abdomen radiotherapy for stage IA Hodgkin's disease. This represents the fourth such case reported. The risk of secondary AML after ABVD or radiation therapy is discussed.
KEY WORDS acute myeloid leukemia; Hodgkin's disease; ABVD; radiation therapy; secondary leukemia CASE REPORT Hodgkin's disease is a curable tumour in the vast majority of cases. '** Long-term complications in patients treated with single or combined modalities have been observed in survivors, the most serious being secondary malignancies, and in particular acute l e ~k e m i a . ~ Ten year cumulative incidence rates vary from 1.5-10, with higher rates in treatments that include MOPP with or without ABVD or radiation therapy. We are aware of only three reports of acute leukemia in cases where ABVD was given alone or in combination with radiation.46 We wish to report a fourth case in a man treated with ABVD and radiation therapy.
The patient is a male who presented in January 1991 at the age of 23, with a right submandibular lump. This was initially observed. A biopsy was performed in September 1991 and a diagnosis of Hodgkin's disease, mixed cellularity was made. Staging assessment revealed clinical stage IA disease. He received three courses of standard dose ABVD without dose modification or incidents. This was followed in January 1992 with radiation therapy, 3500 cGy in 20 daily fractions over 4 weeks to the upper mantle followed by 2000 cGy in 20 daily fractions over 4 weeks to the para-aortic lymph nodes and spleen. He achieved a complete remission and other than mild depression, he remained well.
In June 1994, he developed progressive pancytopenia and bone marrow aspirate and biopsy revealed a diagnosis of myelodysplasia (FAB-RAEB). He was referred to the Leukemia Service of this hospital for management. Since no relatives were available and given the predictable poor outcome of secondary acute leukemia, search for an unrelated bone marrow donor was initiated. In August, he developed Herpes zoster in the distribution of the ophthalmic branch of the left