Can leukemia be triggered by chemotherapy or radiation therapy for tumor patients?

Anti-tumor therapy includes chemotherapy and radiotherapy, and treatment is followed by myelosuppressive manifestations such as leukopenia, anemia, and thrombocytopenia. Patients may experience infections, fever, bleeding and some other manifestations of side effects of radiotherapy, which can be improved by symptomatic supportive therapy. These symptoms can improve or even disappear after the patient’s myelosuppression period, and are not directly or necessarily related to the development of acute leukemia.

Chemotherapy and radiation therapy have significantly improved survival rates for cancer patients over the past few decades. However, as cancer survivors live longer, the incidence of leukemia has increased each year.

Radiotherapy may cause DNA base shedding, conversion, and reversal in hematopoietic stem cells to produce shift mutations or point mutations, and may break DNA chains, producing genetic mutations and chromosomal aberrations that increase the incidence of leukemia, with chromosomal aberrations that are dose-dependent and irreversible with radiotherapy. However, most scholars believe that the incidence of leukemia caused by radiation therapy alone is low, generally less than 4%.

Alkylating agents in chemotherapy are recognized mutagenic agents that cross-link with DNA to cause genetic mutations, activate the oncogene RAS, and mutate the oncogene p53, leading to uncontrolled cell proliferation and impaired differentiation causing leukemia.

These risks are related to the treatment regimen of the tumor, with chemotherapy having a high risk, radiotherapy alone having the lowest risk, total body irradiation having a higher risk than high-dose local irradiation, and a positive correlation between the intensity of treatment the patient receives and the risk of leukemia development.

Thus, there may be some association between radiation and chemotherapy for tumors and secondary leukemia, but the probability is extremely low in one case and can be relatively circumvented in the other. After all, tumor treatment has significantly improved the quality of life and survival for most patients, and there is no need to “talk about the tiger”.