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.
Shen
Yu-Mei
YM
Department of Pediatrics, Hsin Chu General Hospital, Hsinchu, Taiwan.
Hung
Giun-Yi
GY
Yen
Hsiu-Ju
HJ
Hsieh
Ming-Yun
MY
Hsieh
Te-Kuei
TK
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