Therapy-Related Myeloid Neoplasms in Patients With Acute Promyelocytic Leukemia Treated With All-Trans-Retinoic Acid and Anthracycline-Based Chemotherapy

Abstract

t-MN is a relatively infrequent, long-term, and severe complication after first-line treatment for APL with ATRA and anthracycline-based regimens. Therapeutic strategies to reduce the incidence of t-MN are warranted.

Chronic Myeloid Leukemia Developing After Successful Treatment of Acute Promyelocytic Leukemia

“…Furthermore, the accumulation of chemotherapeutic agents in maintenance phase may also increase the risk of t-MN [11]. Data from Programa Español para el Tratamiento de Enfermedades Hematológicas study showed that t-MN developed in 1.8 % APL patients who received ATRA and anthracycline-based chemotherapy [12]. Elimination of VP-16 may explain partially the lower incidence of t-MN as compared with the Japanese study.…”

Therapy-related myelodysplastic syndrome after successful treatment of acute promyelocytic leukemia: case report and literature review

“…During the last couple of years multiple reports on treatment-related neoplasia have been published: t-MDS and t-AML in patients with complete remission after APL treated by standard protocol with ATRA and anthracyclinebased chemotherapy (AIDA) [7,19,20,21,23,24].…”

“…t-MNs have been more often associated with treatment of solid tumors and malignant lymphomas and less with the treatment of acute leukemia [6,7].…”

“…In the last couple of years, in the specialty literature, there have been several case reports of t-MNs after successful treatment for APL with regimens including ATRA + anthracycline or ATRA + ATO [7,19,20]. t-MDS and t-AML after CR of APL have become an emerging problem [21].…”

Loss of response to azacitidine is associated with deletion 12p13 in a patient with myelodysplastic syndrome with unique translocation t(13;17)(q12;q25) after prior breast cancer and acute promyelocytic leukemia

“…They are characterized by lesions of chromosomes 5 and 7 and poor survival (median 7-10 months) [3,4]. Azacitidine may be a reasonable treatment choice [5] although safety concerns in patients with complex cytogenetics [6] or previous acute promyelocytic leukemia (APL) exist [7].…”