Acute Myeloid Leukemia Occurring in Responders to the 9/11 Attack on the World Trade Center: A Single Institution Case Series

Responders to the 9/11/01 attack on the World Trade Center (WTC) were exposed to a variety of toxins resulting from the combustion of jet fuels, collapse of the towers, smoldering fires, and diesel exhaust generated by heavy equipment during debris removal. These toxins included polycyclic aromatic hydrocarbons, polychlorinated biphenyls and furans, and dioxins. The potential for subsequent development of secondary malignancies has been of concern. We report a single institution series of 6 cases of acute myeloid leukemia (AML) occurring in responders to the WTC disaster. All spent extended periods of time at Ground Zero. Case Age WTC Role 9/11 to Dx (months) FAB Karyotype Response Status 1 38 Construction worker 29 M2 46, XY CR Relapse at 33 mos; expired 2 43 Bus driver 57 M4 48, XY, +8, +11 CMMoL Alive s/p allo SCT 3 38 Glass cutter 71 M3 46, XY, t (15;17) CR Alive 4 53 Police 74 M4 46, XY CR Relapse at 8 mos; alive 5 45 Police 79 M1 46, XY CR Alive 6 62 Police 79 M5a 46, XY CR Alive AML arising in WTC responders after a latency period of at least 29 months raises the possibility of an association. There are no distinctive characteristics apparent in this small single institution series. Case 2 has myelodysplasia at a relatively young age, consistent with a possible toxic etiology. AML patients should be questioned regarding activity at Ground Zero and identified cases should be asked about the duration and types of exposure at the WTC, in addition to other occupational or environmental exposures. Clinicians should report cases of hematologic malignancy in WTC responders to the appropriate state cancer registry to facilitate epidemiologic investigation. Studies of cancer among persons exposed to the 9/11 disaster are ongoing by the New York City Fire Department, the WTC Medical Monitoring and Treatment Program and the WTC Health Registry.