Acute promyelocytic leukemia in an HIV‐infected patient: A case report

Vita, Serena De; Matteis, Silvia De; Laurenti, Luca; Sorà, Federica; Tarnani, Michela; Cingolani, Antonella; Sica, Simona

doi:10.1002/ajh.20553

Cited by 8 publications

(8 citation statements)

References 4 publications

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“…In those reported cases, patient treated with the combined therapy of ATRA and chemotherapy entered a remission [1-5]. However, only two patients who concomitantly received antiretroviral therapy achieved sustained remission [2,3]. Our patient achieved stable complete remission with induction therapy of ATRA and antracycline followed by reduced intensity consolidation therapy with ATRA, and concomitant HAART.…”

Section: To the Editormentioning

confidence: 63%

Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

et al. 2009

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The occurrence of acute promyelocytic leukemia (APL) in HIV-infected patients has been reported in only five cases. Due to a very small number of reported HIV/APL patients who have been treated with different therapies with the variable outcome, the prognosis of APL in the setting of the HIV-infection is unclear. Here, we report a case of an HIV-patient who developed APL and upon treatment entered a complete remission. A 25-years old male patient was diagnosed with HIV-infection in 1996, but remained untreated. In 2004, the patient was diagnosed with primary central nervous system lymphoma. We treated the patient with antiretroviral therapy and whole-brain irradiation, resulting in complete remission of the lymphoma. In 2006, prompted by a sudden neutropenia, we carried out a set of diagnostic procedures, revealing APL. Induction therapy consisted of standard treatment with all-trans-retinoic-acid (ATRA) and idarubicin. Subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission. Due to the poor general condition, consolidation treatment with ATRA was given in March and April 2007. The last follow-up 14 months later, showed sustained molecular APL remission. In conclusion, we demonstrated that a complete molecular APL remission in an HIV-patient was achieved by using reduced-intensity treatment.

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Section: To the Editormentioning

confidence: 63%

Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

et al. 2009

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“…Patients with a CD4 cell count of <200×10 6 cells per liter have a median survival time of 7 weeks, while patients with a CD4 cell count >200×10 6 cells per liter have a median survival of 7 months [1]. Although long-lasting chemotherapy-induced responses are rare, the majority of treated patients do achieve complete hematologic remissions [1,6,10]. Treatment-related morbidity does not appear to be excessive [1,2,4,6].…”

Section: Discussionmentioning

confidence: 99%

“…Role of combination chemotherapy and HAART needs further Fig. 1 Abnormally large myelogenous leukemic cells evaluation in these patients [6,7,10]. Rescue treatment with autologous stem cell transplantation was used in an asymptomatic HIV patient with AML [11].…”

Section: Discussionmentioning

confidence: 99%

Acute myelogenous leukemia in a child with HIV infection

et al. 2009

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The occurrence of acute myelogenous leukemia (AML) in HIV-infected patients is extremely rare with only adult patients reported so far. Our patient was a 7-year-old male who presented with fever and cough since 1 month with six episodes of intermittent hemoptysis. The child also had recurrent parotid swellings, melena, and purulent otitis media. Investigations revealed anemia (hemoglobin of 8.9 g/dl), thrombocytopenia (platelet count of 21,000 cells per microliter), and positive HIV antibody (perinatal transmission). The patient's bone marrow aspiration and biopsy suggested AML, and the leukemia panel 1 study showed CD13, CD33, CD34, and HLA DR-positive AML with CD7 expression. The child was given supportive treatment but succumbed to the disease. AML can occur in pediatric patients with HIV infection. A high index of suspicion of hematological malignancies should be kept in mind for patients presenting with cytopenias. This is the first HIV-infected pediatric patient (<12 years) with AML reported in the medical literature.

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“…To the best of our knowledge, since 1997 only a few cases of APL have so far been reported among PLWH, as recently reviewed by Kunitomi et al [65] and summarized in Table 3, thereby avoiding the possibility to give any evidence-based recommendation on therapeutic management of this uncommon clinical entity [65,66]. In the majority of cases, the diagnosis of HIV infection preceded the occurrence of APL by at least two years and most patients received ART, as summarized in Table 3 [35,[65][66][67][68][69][70][71][72]. These ten adult patients received remission induction treatment with ATRA, either alone or, more commonly, in combination with chemotherapy, mainly anthracyclines, achieving at least morphologic CR in all but one cases, followed by consolidation/maintenance therapeutic approaches.…”

Section: How Should Acute Promyelocytic Leukemia Be Approached In Plwh?mentioning

confidence: 99%

“…However, detailed information on obtainment and maintenance of molecular CR is lacking for some patients, as reported in Table 3. Of note, most patients remained alive during the observation period, with last clinical follow-up since APL diagnosis ranging from 8 to 40 months (Table 3) [35,[65][66][67][68][69][70][71][72]. Interestingly, in previous in vitro studies, despite ATRA was found to up-regulate HIV mRNA transcription in HIV-infected human HL-60 cell line, no corresponding increase in viral replication was documentable due to a block in HIV mRNA translation and replication, causing the HIV-infected cells to eventually undergo apoptosis [73].…”

Section: How Should Acute Promyelocytic Leukemia Be Approached In Plwh?mentioning

confidence: 99%

Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers

Forghieri

Nasillo

Bettelli

et al. 2020

IJMS

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Both human immunodeficiency virus (HIV) infection and acute myeloid leukemia (AML) may be considered relatively uncommon disorders in the general population, but the precise incidence of AML in people living with HIV infection (PLWH) is uncertain. However, life expectancy of newly infected HIV-positive patients receiving anti-retroviral therapy (ART) is gradually increasing, rivaling that of age-matched HIV-negative individuals, so that the occurrence of AML is also expected to progressively increase. Even if HIV is not reported to be directly mutagenic, several indirect leukemogenic mechanisms, mainly based on bone marrow microenvironment disruption, have been proposed. Despite a well-controlled HIV infection under ART should no longer be considered per se a contraindication to intensive chemotherapeutic approaches, including allogeneic hematopoietic stem cell transplantation, in selected fit patients with AML, survival outcomes are still generally unsatisfactory. We discussed several controversial issues about pathogenesis and clinical management of AML in PLWH, but few evidence-based answers may currently be provided, due to the limited number of cases reported in the literature, mainly as case reports or small retrospective case series. Prospective multicenter clinical trials are warranted to more precisely investigate epidemiology and cytogenetic/molecular features of AML in PLWH, but also to standardize and further improve its therapeutic management.

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Acute promyelocytic leukemia in an HIV‐infected patient: A case report

Cited by 8 publications

References 4 publications

Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

Acute myelogenous leukemia in a child with HIV infection

Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers

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