Early development of acute myeloid leukemia following treatment of osteosarcoma: a case report and review of the literature.
We report a case of treatment-related acute myeloid leukemia (t-AML) in a 16-year-old male following treatment for osteosarcoma (OS). He had been treated with a protocol comprising neoadjuvant chemotherapy, definitive surgery with wide excision and adjuvant chemotherapy for OS. Four months after completion of the treatment, a routine hemogram showed hyperleukocytosis with 90% blasts. Bone marrow aspirate and a chromosomal analysis disclosed acute myeloid leukemia (AML), M5b with 46, XY, t(11;19)(q23;p13.3). The t-AML was characterized by early development (just 4 months after completion of chemotherapy for OS) and generalized leukemia cutis. The patient received an alkylating agent (ifosfamide) and DNA topoisomerase II-targeted drugs (etoposide and doxorubicin). In terms of latency, cytogenetics, and presentation, DNA topoisomerase II-targeted drug-related leukemia seemed likely for this patient. Clinically, his leukemia cutis had developed during a nadir in white blood cell count after the first induction of chemotherapy for AML. The rapid progression and its refractoriness to chemotherapy were poor prognostic signs.
Department of Pediatrics, Hsin Chu General Hospital, Hsinchu, Taiwan.
Yu-Mei
YM
Shen
Giun-Yi
GY
Hung
Hsiu-Ju
HJ
Yen
Ming-Yun
MY
Hsieh
Te-Kuei
TK
Hsieh
D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000209:etiology*; D008297:Male; D016609:Neoplasms, Second Primary / Q000209:etiology*; D012516:Osteosarcoma / Q000188:drug therapy*; D059005:Topoisomerase II Inhibitors
D018906:Antineoplastic Agents, Alkylating; D059005:Topoisomerase II Inhibitors