A Case of Acute Promyelocytic Leukemia after Iodine-131 Treatment for Thyroid Cancer

Abstract

Radioactive iodine ( 131 I) has been used in the treatment of thyroid cancer to eliminate residual thyroid tissue after thyroidectomy and to treat metastatic disease. Leukemia has rarely been reported as a late complication of 131 I therapy, occurring most frequently after receiving a cumulative activity of 800 mCi of the radioisotope. Although FAB M3 type (acute promyelocytic leukemia, APL) as the secondary acute leukemia had been rarely reported, recently there have been a few cases of therapy-related APL leukemia seen. We hereby report a case of secondary acute promyelocytic leukemia occurring in a patient who received radioactive iodine therapy for papillary thyroid carcinoma. An assessment of causality using the Naranjo probability scale showed that a possible relationship existed between APL seen in the patient and the use of the radioactive iodine. Although this is a very rare event, strict hematologic follow-up of patients treated with radioactive iodine may be warranted, along with a high index of suspicion in those with coagulopathy.

Interstitial Deletion of Chromosome 9q in Therapy-Related Acute Promyelocytic Leukemia with Pathognomonic t(15;17) in a Patient Exposed to Radioactive Iodine

“…This translocation causes fusion of Retinoic Acid Receptor-alpha (RAR-alpha, RARa) gene on chromosome 17 and the Promyelocytic Leukemia (PML) gene on chromosome 15. Although several cases of t-APL have been identified, only six cases of t-APL have been reported after RAI therapy [4][5][6][7][8][9]. Deletion in…”

Four Cases of Hematologic Malignancy Following Radioactive Iodine Therapy for Thyroid Cancer

“…국내에서는 방사성 요오드 치료와 관련하여 발생한 이차성 혈액종양으로 French-American-British (FAB) 분류에 의한 AML M1, M3 및 급성림프모구백혈병(ALL) L1이 각각 1예씩 보고되었으며 M3 증례는 t(15;17)(q22;q21), L1 증례는 t(11;19) (q23;p13) 핵형 이상을 동반하였다 [7][8][9] Ionizing radiation including I 131 might produce chromosomal translocation, causing hematologic malignancy. The incidence of leukemia following radioactive iodine treatment for thyroid cancer has been reported to be approximately 0.1 to 2.0% in Western countries, whereas fewer cases have been reported in Korea.…”