Distinct cytogenetic and clinicopathologic features in acute myeloid leukemia after occupational exposure to pesticides and organic solvents

Abstract

Background. To study the correlation of environmental exposure to potentially mutagenic agents and the clinicopathologic picture in acute myeloid leukemia (AML), clinical features, morphologic characteristics, immuno‐phenotype, and cytogenetics were studied in 59 patients with newly diagnosed AML. Methods. Based on interviews on occupational hazards and hobbies showing prolonged contact with pesticides (18 patients) and organic solvents (7 patients), 25 patients were categorized as “exposed.” Thirty‐four patients were categorized as “unexposed,” based on anamnestic findings. Results. Light microscopic studies showed myelodysplasia involving multiple cell lineages in all assessable patients with professional exposure to pesticides and organic solvents, whereas morphologic aberrations of the non‐blast cell population were confined to a minority of cells in unexposed patients. These findings were confirmed by electron microscopic studies in 31 patients. Immunologic analysis showed the presence of a minor megakaryoblastic component in six exposed patients and showed positive findings for the CD34 stem cell marker in 85% of exposed patients, a figure significantly higher as compared with that for unexposed subjects. Cytogenetic studies confirmed the frequent occurrence of 5q and/or 7q aberrations in patients occupationally exposed (10 of 25 cases). Other recurring chromosome aberrations in the exposed group were 17p‐, trisomy 11q, and trans‐location of 16q, 6p, 7p, and 11p, whereas the classic AML‐specific translocations (i.e., t[15;17]; t[8;21]) were detected only in unexposed subjects. Conventional chemotherapy achieved complete remission in 1 of 19 exposed patients, as opposed to 14 of 29 unexposed patients, with a median survival of 2 months in the former group and 8 months in the latter. Conclusions. Taken together, these findings document that AML in patients professionally exposed to toxic substances may represent a distinct cytogenetic and clinicopathologic entity. The clinicobiologic characteristics in these exposed patients are similar to the features of AML arising in patients with prior chemotherapy for another tumor, thus suggesting that similar transformation pathways may underlie leukemogenesis induced by cytotoxic drugs and by environmental exposure to some pesticides or organic solvents. Cancer 1992; 70:77–85.

Hematological malignancies with a deletion of 11q23: cytogenetic and clinical aspects

“…21 Karyotypes for the following six patients have been published previously: 147, 22 288, 23 375, 24 503, 25 521 and 542. 26 …”

Acute myeloid leukemia and clonal chromosome aberrations in relation to past exposure to organic solvents

“…Exposure was not associated with any specific morphology in one study (27), whereas others have indicated increased risks for acute myelomonocytic leukemia after benzene (28) and pesticide (29) exposures, increased risk for acute promyelocytic leukemia in electricians (30), and a possible association between exposure to solvents, insecticides, or petroleum products and erythroleukemia (3 1). With regard to clonal chromosome abnormalities, in some studies, AML patients exposed to solvents or pesticides (31)(32)(33) or "chemicals" (27,34) had a higher proportion of clonal chromosome abnormalities (especially complete or partial loss of chromosome 5 or 7, and trisomy 8), but not in others (16,35,36). It has also been suggested that AML in association with previous toxic occupational exposures has a worse prognosis and represents a distinct clinical, as well as cytogenetic, entity (32).…”

“…With regard to clonal chromosome abnormalities, in some studies, AML patients exposed to solvents or pesticides (31)(32)(33) or "chemicals" (27,34) had a higher proportion of clonal chromosome abnormalities (especially complete or partial loss of chromosome 5 or 7, and trisomy 8), but not in others (16,35,36). It has also been suggested that AML in association with previous toxic occupational exposures has a worse prognosis and represents a distinct clinical, as well as cytogenetic, entity (32).…”

Clinical features of hematopoietic malignancies and related disorders among benzene-exposed workers in China. Benzene Study Group.

“…Although cytogenetic studies were not performed as part of the routine diagnostic evaluation of HLD cases arising among Chinese benzene-exposed workers, morphologic and hematologic similarities between our cases and treatment-related AMLs suggest possible similarities in pathogenesis, perhaps involving damage to marrow stem cells and/or extramedullary mediators of carcinogenesis. Similarly, a recent clinicopathologic description of AML following exposure to organic solvents revealed comparable types of abnormalities (116).…”