Antineoplastics
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Reactions 1394 - 24 Mar 2012 S Antineoplastics Chronic myelomonocytic leukaemia: case report A man in his 60s developed chronic myelomonocytic leukaemia (CMML) while receiving antineoplastics for acute promyelocytic leukaemia (APL). The man was diagnosed with APL in August 2007 at the age of 61 years and achieved complete remission in October 2007 after induction treatment with tretinoin, idarubicin and cytarabine [dosages, routes and durations of treatment not stated]. He received two subsequent consolidation courses with idarubicin (total dose 99 mg/m 2 ) and cytarabine [dosage information incomplete; routes not stated] and started maintenance treatment with mercaptopurine, methotrexate and sequential tretinoin in January 2008 [dosages and routes not stated]. In March 2009, after 14 months of maintenance treatment, he was admitted with diffuse skeletal pain. On examination he was found to have splenomegaly. Laboratory investigations revealed leucocytosis (106 × 10 9 /L) with 43% immature granulocytes, thrombocytopenia (37 × 10 9 /L) and a haemoglobin level of 12.3 g/dL. Bone marrow examination showed hyperplasia with eosinophilia but no blast excess. Karyotype analysis of the bone marrow revealed translocation t(5;12) (q33;p13), and PCR analysis confirmed the presence of the ETV6-platelet-derived growth factor receptor beta (PDGFRB) fusion gene. Maintenance treatment with mercaptopurine, methotrexate and tretinoin was stopped, and imatinib was started. The man’s condition improved rapidly. His bone pain resolved on the first day, and his leucocyte count and spleen size normalised within a few days. At last follow-up in September 2010, he was well and continued treatment with imatinib. Retrospective study of DNA samples showed that the ETV6-PDGFRB transcript was absent at the time of APL diagnosis and after induction chemotherapy, but appeared 6 months before CMML diagnosis. Author comment: "The absence of the ETV6-PDGFRB transcript at diagnosis suggested therapy-related disease rather than a coexisting underlying clone detected after APL remission." Malfuson JV, et al. Therapy-related myeloproliferative neoplasm with ETV6-PDGFRB rearrangement following treatment of acute promyelocytic leukemia. Annals of Hematology 90: 1477-9, No. 12, Dec 2011 - France 803068307 1 Reactions 24 Mar 2012 No. 1394 0114-9954/10/1394-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1394 - 24 Mar 2012
SAntineoplastics
Chronic myelomonocytic leukaemia: case reportA man in his 60s developed chronic myelomonocytic
leukaemia (CMML) while receiving antineoplastics foracute promyelocytic leukaemia (APL).
The man was diagnosed with APL in August 2007 at theage of 61 years and achieved complete remission inOctober 2007 after induction treatment with tretinoin,idarubicin and cytarabine [dosages, routes and durations oftreatment not stated]. He received two subsequentconsolidation courses with idarubicin (total dose99 mg/m2) and cytarabine [dosage information incomplete;routes not stated] and started maintenance treatment withmercaptopurine, methotrexate and sequential tretinoin inJanuary 2008 [dosages and routes not stated]. In March2009, after 14 months of maintenance treatment, he wasadmitted with diffuse skeletal pain. On examination he wasfound to have splenomegaly. Laboratory investigationsrevealed leucocytosis (106 × 109/L) with 43% immaturegranulocytes, thrombocytopenia (37 × 109/L) and ahaemoglobin level of 12.3 g/dL. Bone marrow examinationshowed hyperplasia with eosinophilia but no blast excess.Karyotype analysis of the bone marrow revealedtranslocation t(5;12) (q33;p13), and PCR analysisconfirmed the presence of the ETV6-platelet-derivedgrowth factor receptor beta (PDGFRB) fusion gene.
Maintenance treatment with mercaptopurine,methotrexate and tretinoin was stopped, and imatinib wasstarted. The man’s condition improved rapidly. His bonepain resolved on the first day, and his leucocyte count andspleen size normalised within a few days. At last follow-upin September 2010, he was well and continued treatmentwith imatinib. Retrospective study of DNA samples showedthat the ETV6-PDGFRB transcript was absent at the time ofAPL diagnosis and after induction chemotherapy, butappeared 6 months before CMML diagnosis.
Author comment: "The absence of the ETV6-PDGFRBtranscript at diagnosis suggested therapy-related diseaserather than a coexisting underlying clone detected after APLremission."Malfuson JV, et al. Therapy-related myeloproliferative neoplasm withETV6-PDGFRB rearrangement following treatment of acute promyelocyticleukemia. Annals of Hematology 90: 1477-9, No. 12, Dec 2011 -France 803068307
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Reactions 24 Mar 2012 No. 13940114-9954/10/1394-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
