Early Development of Acute Myeloid Leukemia Following Treatment of Osteosarcoma: A Case Report and Review of the Literature

Abstract

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.

The role of combined ion-beam radiotherapy (CIBRT) with protons and carbon ions in a multimodal treatment strategy of inoperable osteosarcoma

“…Thirteen SMN were reported in the EURAMOS-1 trial (n = 618), most were myeoloid (myelodysplasia or AML) [14]. The most common drugs associated with secondary AML after osteosarcoma treatment are alkylating agents and topoisomerase II inhibitors [28,29], cytogenetic abnormalities are consistent to exposure by those substances [14] Reduced medium and low dose to surrounding tissue in particle therapy results in reduced risk of radiation-induced SMN on dosimetric comparison [30]. In a large case matched comparison (n = 588 per arm, mostly adults) the SMN rates were 5.2% and 7.5% among the proton and photon cohort, respectively [31].…”