Second cancer risk following radiotherapy and chemotherapy is an increasingly important topic in clinical oncology with an impact on treatment decision making and patient management. And leukemia has one of the highest incidences. Much of the evidence that underlies our understanding of second cancer risks and our risk estimates are derived from large epidemiologic studies that we will talk about it and predictive models of earlier decades with large uncertainties. We will focus in our review on the mechanisms that lead to Therapy Related Leukemia and introduce the best strategies of cancer therapies to reduce the risk of second cancer such as Metronomic chemotherapy, hopefully, be used in cancer hospitals, our focus on this highly important issue had started after detection of a case for a cancer patient who was diagnosed with leukemia after a highly intensive regimen for breast cancer treatment which included high doses of chemotherapy and radiotherapy, therefore we aim to highlight the most updated safe administration of cancer treatments in this review to reduce such cases by oncologists worldwide.