malignancy at 5 years was 0.43 (95% CI 016-1.15) and was unchanged at 10 years.Our data allow some interesting considerations. The probability of developing an acute leukemia in patients who received chemotherapy or radiotherapy for a previous malignancy (PM), including acute leukemia, is a well-known occurrence: secondary forms constitute approximately 8% to 10% of all acute leukemias and are usually myeloid. 6 The main reason for this event is that several drugs employed in the treatment of the PM, particularly topoisomerase II inhibitors (epipodophyllotoxins and anthracyclines), and combined chemotherapy including alkylating agents, are considered potentially mutagenic. As suggested by Latagliata et al, 1 the use of intensive chemotherapy to cure APL, with the inclusion of topoisomerase II inhibitors, has a potential role in inducing a tMDS-AML. 7 In our cohort of patients, the number of secondary malignancies is lower than expected in the normal population. The estimated cumulative incidence at 5 and 10 years is also lower than that expected. Furthermore, the brief latency between the onset of the 2 malignancies leads to the hypothesis that the second malignancy is probably not related to the carcinogenic action of the drugs employed for the treatment of APL, but perhaps to a chance association only.These considerations suggest that APL treatment is not relevant in inducing the onset of secondary nonhematological malignancies. On the contrary, the action of topoisomerase II inhibitors, which represent one of the main anticancer drugs used in APL, could favor the development of a tMDS-AML with a leukemogenic action on blood stem cells.