To the Editor:

The report by Douer et al,1 followed by the letters by Otero et al,2 Tomás and Fernández-Rañada,3 and Douer et al,4 that describe a high prevalence of M3-AML among Latinos from Spain, Mexico, Peru, Nicaragua, Venezuela, Brazil, and Italy, adds interesting data to the concept of geographic hematology,5 an area that seemed to be in extinction despite its possible significance in the etiology of certain malignancies. The term Latino describes strictly a variety of populations speaking languages derived from Latin, the language of the old Romans, mainly Italian, Spanish, and Portuguese. Because it is unlikely that there is an association of the prevalence of M3-AML with the native language of the patients, population studies should be performed to identify possible genetic markers of increased susceptibility to the disease or some other variables instead of associating it with a language. We have been interested in geographic hematology6-12 and described that in Mexico, in the Mestizo population (56% of whom have been shown to have Indian genes, 40% white genes, and 4% black genes13 ), the salient features of the geographic distribution of leukemias, as compared with white populations, are: A high prevalence of M3 and M7 leukemias,6-8 a low prevalence of pre-B acute lymphoblastic leukemia,6,9,10 a very low prevalence of chronic lymphocytic leukemia,6,11,12 and a low prevalence of hairy cell leukemia.6,11,12 Despite the fact that the genetic composition of the Mexican Mestizo population is very different from that of the inhabitants of Spain, certain similarities in the prevalence of some leukemias have been found, such as the high prevalence of M7-AML,6,7 and now the high prevalence of M3-AML.3,6 14 

In our single-institution experience with 198 patients with acute leukemia treated during a 10-year period, promyelocytic leukemia represents 20% (12/60) of all patients with myeloid leukemia, and 30% of myeloid leukemias in adolescents (age, 11 to 21 years).14 Interestingly, the current therapeutic approach using all-trans-retinoic acid as front-line therapy in M3 leukemias15 has substantially improved the prognosis of adolescents with acute myeloid leukemia14,16,17 to the point that, possibly because of the high frequency of M3-AML, adolescents with myelogenous leukemia have a better prognosis than those with lymphoblastic leukemia.14 18 These data add information about the increased prevalence of AML among Mexican Mestizos, but not Latinos.

1
Douer
BD
Preston-Martin
S
Chang
E
Nichols
PW
Watkins
KJ
Levine
AM
High frequency of acute promyelocytic leukemia among latinos with acute myeloid leukemia.
Blood
87
1996
308
2
Otero
JC
Santillana
S
Fereyros
G
High frequency of acute promyelocytic leukemia among latinos with acute myeloid leukemia.
Blood
88
1996
377
3
Tomás
JF
Fernández-Rañada
JM
About the increased frequency of acute promyelocytic leukemia among Latinos: The experience from a center in Spain.
Blood
88
1996
2357
4
Doeuer
D
Levine
AM
Preston-Martin
S
Nichols
PW
Response.
Blood
88
1996
2358
5
Arends T, Arends A: Introducción a la hematologı́a geográfica en Iberoamérica, in López-Borrasca A, Arocha-Piñango CL, Campos-Guerra C, Parreira A, Pavlovsky S, Ruiz-Argüelles GJ, San Miguel F (eds): Enciclopedia Iberoamericana de Hematologı́a. Salamanca, Spain, Ediciones Universidad de Salamanca, 1992, p IV-601
6
Ruiz-Argüelles GJ, Ruiz-Reyes G: El tratamiento de las leucemias en paı́ses en desarrollo: El caso de México, in Ruiz-Argüelles GJ, San-Miguel JF (eds): Actualización en Leucemlas. Editorial Médica Panamericana, 1996, p 147
7
Ruiz-Argüelles
GJ
Lobato-Mendizábal
E
San-Miguel
JF
González
M
Caballero
MD
Ruiz-Argüelles
A
Orfao
A
Gómez-Almaguer
D
Vidriales
B
Ruiz-Reyes
G
López-Borrasca
A
Long-term treatment results for acute megakaryoblastic leukaemia patients: A multicentre study.
Br J Haematol
82
1992
671
8
Lobato-Mendizábal E, Ruiz-Argüelles GJ: Problemas en el tratamiento de las hemopatı́as malignas en Iberoamérica, in López-Borrasca A, Arocha-Piñango CL, Campos-Guerra C, Parreira A, Pavlovsky S, Ruiz-Argüelles GJ, San Miguel F (eds): Enciclopedia Iberoamericana de Hematologı́a. Salamanca, Spain, Ediciones Universidad de Salamanca, 1992, p IV-662
9
Lobato-Mendizábal E, Ruiz-Argüelles GJ: Problemas especiales en el tratamiento de las leucemias agudas, in Ruiz-Argüelles GJ (ed): Temas de Medicina Interna: Leucemias agudas. Mexico City, Mexico, Nueva Editorial Interamericana/McGraw-Hill, 1993, p 187
10
Lobato-Mendizábal
E
Ruiz-Argüelles
GJ
Prevalencia y caracterı́sticas de la leucemia linfoblástica de células pre-B en México.
Sangre
36
1991
1
11
Alemán-Hoey
DD
Ruiz-Argüelles
GJ
Verduzco-Rodriguez
L
López-Ariza
B
Labardini
JR
Leucemia linfocı́tica crónica. I. Experiencia de 35 años en el Instituto Nacional de la Nutrición Salvador Zubirán.
Rev Invest Clin Mex
34
1982
151
12
Ruiz-Argüelles
GJ
Cantú-Rodrı́guez
O
Gómez-Almaguer
D
Cortés-Franco
J
Góngora-Biachi
RA
Pizzuto
J
Rodrı́guez-Carrillo
J
Romero-Garcı́a
F
Torre-López
E
Apreza-Molina
MG
Mercado-Dı́az
L
Hairy cell leukemia is infrequent in Mexico and has a geographic distribution.
Am J Hematol
52
1996
316
13
Lisker R, Ramı́rez E, Pérez-Briceño R, Granados J, Babinsky V: Gene frequencies and admixture estimates in four Mexican urban centers. Hum Biology 62:791, 1990
14
Ruiz-Argüelles GJ, Apreza-Molina MG: Outcome of treatment of adolescents with acute leukemia. Blood 1996 (in press)
15
Rubio-Borja ME, Ovilla-Martı́nez R, Labardini J, Gómez-Almaguer D, Ruiz-Argüelles GJ, Gómez-Morales E, Borbolla R: All-trans retinoic acid (ATRA) for acute promyelocitic leukemia (APL): Toxicity and survival from de novo patients. Blood 1994. 84:147a, 1994 (abstr, suppl 1)
16
Ruiz-Argüelles
GJ
Garcés-Eisele
J
Ruiz-Argüelles
A
ATRA-induced gingival infiltration: Report of a case.
Am J Hematol
49
1995
364
17
Ruiz-Argüelles
GJ
Garcés-Eisele
J
Ruiz-Argüelles
A
Continued complete remission after a PML/RARα autograft in acute promyelocytic leukemia.
Eur J Haematol
56
1996
186
18
Ruiz-Argüelles GJ, Gómez-Almaguer D: Leucemia aguda en el adolescente, in Dulanto E (ed): Medicina del adolescente. Mexico City, Mexico, Nueva Editorial Interamericana/McGraw-Hill, 1996 (in press)
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