Abstract
IntroductionTherapy-related acute myeloid leukemia occurs as a complication of treatment with chemotherapy, radiotherapy, immunosuppressive agents or exposure to environmental carcinogens.Case presentationWe report a case of therapy-related acute myeloid leukemia in a 37-year-old Turkish woman in complete remission from breast cancer. Our patient presented to our facility with fatigue, fever, sore throat, peripheral lymphadenopathy, and moderate hepatosplenomegaly. On peripheral blood and bone marrow aspirate smears, monoblasts were present. Immunophenotypic analysis of the bone marrow showed expression of CD11b, CD13, CD14, CD15, CD33, CD34, CD45 and human leukocyte antigen-DR, findings compatible with the diagnosis of acute monoblastic leukemia (French-American-British classification M5a). Therapy-related acute myeloid leukemia developed three years after adjuvant chemotherapy consisting of an alkylating agent, cyclophosphamide and DNA topoisomerase II inhibitor, doxorubicin and adjuvant radiotherapy. Cytogenetic analysis revealed a 46, XX, deletion 7 (q22q34), deletion 20 (q11.2q13.1) karyotype in five out of 20 metaphases and inversion 16 was detected by fluorescence in situhybridization. There was no response to chemotherapy (cytarabine and idarubicin, FLAG-IDA protocol, azacitidine) and our patient died in the 11th month after diagnosis.ConclusionsThe median survival in therapy-related acute myeloid leukemia is shorter compared to de novoacute myeloid leukemia. Also, the response to therapy is poor. In therapy-related acute myeloid leukemia, complex karyotypes have been associated with abnormalities of chromosome 5, rather than 7. To the best of our knowledge, this is the first case of therapy-related acute myeloid leukemia showing the co-presence of deletion 7q, 20q and the inversion 16 signal.
Highlights
Therapy-related acute myeloid leukemia occurs as a complication of treatment with chemotherapy, radiotherapy, immunosuppressive agents or exposure to environmental carcinogens.Case presentation: We report a case of therapy-related acute myeloid leukemia in a 37-year-old Turkish woman in complete remission from breast cancer
In therapy-related acute myeloid leukemia, complex karyotypes have been associated with abnormalities of chromosome 5, rather than 7
To the best of our knowledge, this is the first case of therapy-related acute myeloid leukemia showing the co-presence of deletion 7q, 20q and the inversion 16 signal
Summary
The World Health Organization (WHO) classification of therapy-related myeloid neoplasms (t-MN) includes tAML, t-MDS, or myelodysplastic syndrome/myeloproliferative neoplasms (t-MDS/MPN) that develop secondary to exposure to cytotoxic agents or radiation [7]. Taking into consideration the increase in survival and overall cure rate of patients with cancer, the potential risk of therapy-associated secondary malignancies is of growing interest. In the National Surgical Adjuvant Breast and Bowel Project (NSABP) B25 trial of adjuvant AC chemotherapy for breast cancer, six out of 2534 cases in the high-dose cyclophosphamide/high-dose doxorubicin treatment arm developed M4 or M5 AML, with three patients exhibiting 11q23 abnormalities. Ten other patients developed AML or MDS, with three patients exhibiting M1 or M2 morphology and five patients showing typical alkylating-agent-induced abnormalities of chromosomes 5 or 7 [20]. To the best of our knowledge, our patient’s case is the first case of t-AML showing M5 morphology with del 7q, 20q and the inv(16) signal developed three years after chemoradiotherapy for breast cancer. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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