Antineoplastics
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Reactions 1411 - 21 Jul 2012 S Antineoplastics Acute myeloid leukaemia: 3 case reports One woman and two men developed therapy-related acute myeloid leukaemia (t-AML) after receiving antineoplastics [dosage and route information incomplete] for acute promyelocytic leukaemia (APL). All three patients had been successfully treated according to the PETHEMA regimen, consisting of oral tretinoin 45 mg/m 2 /day and idarubicin 12 mg/m 2 /day on days 2, 4, 6 and 8. After achieving complete remission, patients received three 1-month consolidation courses with idarubicin 5 mg/m 2 /day on days 1–4, mitoxantrone 10 mg/m 2 /day on days 1–5 and idarubicin 12 mg/m 2 /day. Maintenance therapy, which was scheduled to continue for 2 years, consisted of mercaptopurine 50 mg/m 2 /day, methotrexate 15 mg/m 2 /week and tretinoin 45 mg/m 2 /day for 15 days every 3 months. A woman, who was diagnosed with APL at 52 years of age, developed pancytopenia 9 months after completing PETHEMA treatment. Bone marrow biopsy revealed therapy-related myeloid neoplasm (TMN). She received idarubicin and cytarabine (3 + 7); however, within 1 month she transformed to t-AML. One month later, she developed myeloid sarcoma in an oesophageal mass, and 3 months later, she died from multiorgan failure. A man, who had been diagnosed with APL at 49 years of age, presented with TMN 2 years after PETHEMA therapy. Cytogenetic analysis showed chromosome 7 deletion. He underwent allogeneic stem cell transplant; however, 5 months later, he had relapsed TMN. He received two cycles of FLAG-Ida chemotherapy, consisting of fludarabine, cytarabine, idarubicin and a granulocyte colony-stimulating factor, and a donor lymphocyte infusion. Fifteen months after his first relapse, he transformed to t-AML. Despite a treatment trial with AVN-944, he died from AML 4 months later. A second man was diagnosed with APL at 25 years of age. Twenty-three months later, he presented with petechiae after a single dose of ibuprofen. Bone marrow analysis showed t-AML, while cytogenetic analysis revealed t(9;11) translocation. After treatment with mitoxantrone and cytarabine, his bone marrow biopsy was free of leukaemia and cytogenetic analysis were negative for the translocation. He then underwent peripheral stem cell transplant, and was alive after 6 years’ follow-up. Kelemen K, et al. RAS mutations in therapy-related acute myeloid leukemia after successful treatment of acute promyelocytic leukemia. Leukemia and Lymphoma 53: 999-1002, No. 5, May 2012. Available from: URL: http:// dx.doi.org/10.3109/10428194.2011.634047 - USA 803073741 1 Reactions 21 Jul 2012 No. 1411 0114-9954/10/1411-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1411 - 21 Jul 2012
SAntineoplastics
Acute myeloid leukaemia: 3 case reportsOne woman and two men developed therapy-related
acute myeloid leukaemia (t-AML) after receivingantineoplastics [dosage and route information incomplete]for acute promyelocytic leukaemia (APL).
All three patients had been successfully treatedaccording to the PETHEMA regimen, consisting of oraltretinoin 45 mg/m2/day and idarubicin 12 mg/m2/day ondays 2, 4, 6 and 8. After achieving complete remission,patients received three 1-month consolidation courses withidarubicin 5 mg/m2/day on days 1–4, mitoxantrone10 mg/m2/day on days 1–5 and idarubicin 12 mg/m2/day.Maintenance therapy, which was scheduled to continue for2 years, consisted of mercaptopurine 50 mg/m2/day,methotrexate 15 mg/m2/week and tretinoin 45 mg/m2/dayfor 15 days every 3 months.
A woman, who was diagnosed with APL at 52 years ofage, developed pancytopenia 9 months after completingPETHEMA treatment. Bone marrow biopsy revealedtherapy-related myeloid neoplasm (TMN). She receivedidarubicin and cytarabine (3 + 7); however, within 1 monthshe transformed to t-AML. One month later, she developedmyeloid sarcoma in an oesophageal mass, and 3 monthslater, she died from multiorgan failure.
A man, who had been diagnosed with APL at 49 years ofage, presented with TMN 2 years after PETHEMA therapy.Cytogenetic analysis showed chromosome 7 deletion. Heunderwent allogeneic stem cell transplant; however,5 months later, he had relapsed TMN. He received twocycles of FLAG-Ida chemotherapy, consisting offludarabine, cytarabine, idarubicin and a granulocytecolony-stimulating factor, and a donor lymphocyteinfusion. Fifteen months after his first relapse, hetransformed to t-AML. Despite a treatment trial withAVN-944, he died from AML 4 months later.
A second man was diagnosed with APL at 25 years of age.Twenty-three months later, he presented with petechiaeafter a single dose of ibuprofen. Bone marrow analysisshowed t-AML, while cytogenetic analysis revealed t(9;11)translocation. After treatment with mitoxantrone andcytarabine, his bone marrow biopsy was free of leukaemiaand cytogenetic analysis were negative for thetranslocation. He then underwent peripheral stem celltransplant, and was alive after 6 years’ follow-up.Kelemen K, et al. RAS mutations in therapy-related acute myeloid leukemia aftersuccessful treatment of acute promyelocytic leukemia. Leukemia and Lymphoma53: 999-1002, No. 5, May 2012. Available from: URL: http://dx.doi.org/10.3109/10428194.2011.634047 - USA 803073741
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Reactions 21 Jul 2012 No. 14110114-9954/10/1411-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
