Two cases of therapy-related acute promyelocytic leukemia (t-APL) after mantle cell lymphoma and gestational trophoblastic disease.
We report two cases of secondary acute promyelocytic leukemia (APL). One patient presented with concurrent APL and missed abortion 1 year after etoposide-based chemotherapy for gestational trophoblastic disease. A prolonged complete remission was achieved with standard chemotherapy. An elderly man developed APL 1 year after alkylator-based chemotherapy for mantle cell lymphoma (MCL). A complete clinical and molecular remission was obtained with chemotherapy and all- trans retinoic acid, followed by arsenic consolidation. Concomitant molecular relapse of APL and MCL clones was detected at 1 year, both of which responded to oral arsenic therapy. High-dose epipodophyllin is a dose risk for secondary APL, but alkylating agents may also be implicated. For patients with a history of active malignancy and heavy previous chemotherapy exposure, the use of nontoxic arsenic therapy appeared to be effective and prudent.
Au
W Y
WY
University Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. auwing@hotmail.com
Ma
S K
SK
Chung
L P
LP
Chim
C S
CS
Kwong
Y L
YL
D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use*; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000209:etiology; D010087:Oxides / Q000627:therapeutic use*; D011247:Pregnancy; D014212:Tretinoin / Q000627:therapeutic use
D018906:Antineoplastic Agents, Alkylating; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D005047:Etoposide; D000077237:Arsenic Trioxide