title: Therapy-related acute promyelocytic leukemia caused by hormonal therapy and radiation in a patient with recurrent breast cancer.
abstract: We report a patient with therapy-related acute promyelocytic leukemia (APL) that may have been caused by regional radiation or hormonal therapy after surgery. A 36-year-old Japanese woman developed right breast cancer and underwent breast-conserving surgery and regional radiation to the right breast without adjuvant systemic therapy because she wished to preserve her fertility. Two years later, she developed multiple bone metastases of breast cancer and received hormonal therapy. During the second line hormonal therapy, she developed APL and received induction and consolidation chemotherapy with all-trans retinoic acid (ATRA) and a combination of anthracycline and cytarabine. After she achieved a complete remission (CR) of the APL, her bone metastases of breast cancer progressed. She received weekly paclitaxel treatments and her bone marrow function recovered. However, 9 months later, her APL relapsed; she achieved a second CR after undergoing ATRA therapy again. This patient is thought to be a rare case of secondary leukemia, since the leukemia might have been caused by hormonal therapy and regional radiation without chemotherapy.
authors.affiliation: Breast and Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Ono
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Chikako
authors.initials: C
authors.lastname: Shimizu
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hiramoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Goto
authors.forename: Kan
authors.initials: K
authors.lastname: Yonemori
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kouno
authors.forename: Masashi
authors.initials: M
authors.lastname: Ando
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamura
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Katsumata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000139:chemically induced*; D007953:Leukemia, Radiation-Induced / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000188:drug therapy; D016609:Neoplasms, Second Primary / Q000139:chemically induced*