Leukemia Often Is Preceded by Mediastinal Germ Cell Tumors

OKLAHOMA CITY—While the association between mediastinal germ cell tumors (MGCT) and acute megakaryoblastic (M7) leukemia has been known for many years, the relationship is not always fully understood.

To remedy that, a study team including researchers from the Oklahoma City VAMC conducted a review to better characterize the coexistence of these entities as well as the salient features, the treatment options, and the overall prognosis.

For the report in the Annals of Hematology, researchers searched PUBMED, Medline, and EMBASE databases via OVID engine for primary articles and case reports under keywords “germ cell tumors” and “acute myeloid leukemia,” which revealed 26 cases in English that reported MGCT and M7 leukemia.1

In those studies, the median age at diagnosis of MGCT was 24 (13-36) years, and all cases were stage III. In addition, all cases of MGCT were of non-seminomatous origin, with one case was unclassified.

The report noted that MGCT occurred prior to the diagnosis of leukemia in 46% of cases and concomitantly in 31% of cases. In fact, M7 leukemia was never reported prior to the appearance of MGCT, the authors point out.

Complex cytogenetics and hyperdiploidy were the most commonly reported cytogenetic abnormalities. In the 23 cases where the treatment regimen was available, platinum-based chemotherapy directed towards management of the germ cell tumors was used initially in 21 cases and leukemia-directed treatment was used initially in 2 cases only. The median time from diagnosis of MGCT to development of M7 leukemia was 5 (2.25-39) months. Median time to death from the initial diagnosis of MGCT was 6 (0.5-60) months.

“Patients with a history of MGCT are at higher risk of developing M7 leukemia,” study authors concluded. “They need long-term follow-up with a particular attention to the development of hematological malignancies. The overall prognosis remains poor.”

1.    Mukherjee S, Ibrahimi S, John S, Adnan MM, Scordino T, Khalil MO, Cherry M.Non-seminomatous mediastinal germ cell tumor and acute megakaryoblastic leukemia.Ann Hematol. 2017 Jun 3. doi: 10.1007/s00277-017-3037-3. [Epub ahead of print]

Review. PubMed PMID: 28578457.

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