Strontium-89/ Prostate Cancer and AML

[Chris Alston <alstonc@odrge.odr.georgetown.edu>]

>Sender: Medical Physics Mailing List <medphys@LISTS.WAYNE.EDU>
>From: Van McComas <McComasVan@AOL.COM>

>Strontium-89 Use in Prostate Cancer Patients May Increase Risk of AML
>WESTPORT, Feb 01 (Reuters Health) - Researchers are reporting two instances
>of acute myelogenous leukemia that developed in men with adenocarcinoma of
>the prostate who were treated with strontium-89.
>Dr. Mark A. Weiss of the Memorial Sloan-Kettering Cancer Center in New York
>and Dr. Steven E. Kossman of Cornell University Medical College also in New
>York, describe the cases in the February 1st issue of Cancer. In the first
>case, a 74-year old man who had undergone radical prostatectomy in 1983 for
>adenocarcinoma of the prostate, relapsed and developed destructive
>lumbosacral osseous metastases in 1995.  He received 3.7 millicuries
>intravenous strontium-89 in 1996 and 4.14 millicuries in 1997 for palliation
>of skeletal pain.  The patient developed AML 17 months after exposure to
>strontium-89, Drs. Weiss and Kossman report.
>In the second case, a 70-year old man with prostate carcinoma with osseous
>metastases received intravenous injections of strontium-89 in 1996 and 1997
>totaling 15.9 millicuries. The patient also received estramustine and
>vinblastine.  AML became evident 26 months after first receiving strontium-89
>therapy.
>These cases "...suggest the leukemogenic potential of strontium-89 treatment
>in humans," Drs. Weiss and Kossman conclude.
>The researchers note that a "...comprehensive review of the literature
>documented no human cases of [acute myelogenous leukemia] after therapy with
>strontium-89."  They add that "[t]his may reflect the fact that the majority
>of patients with prostate carcinoma treated with strontium-89 already have
>hormone-refractory extensive disease with life expectancies shorter than the
>interval required for leukemogenesis."
>"As this agent is used more frequently (and earlier in the disease course) in
>patients with prostate carcinoma, an increased incidence of secondary AML
>complicating the clinical management of patients with prostate carcinoma may
>be observed," the authors suggest.
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