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Therapy-related myeloid neoplasms as a concerning complication in acute promyelocytic leukemia

María del Carmen Vicente-Ayuso, María García-Roa, Ataúlfo González-Fernández, Ana María Alvarez-Carmona, Celina Benavente-Cuesta, Marta Mateo-Morales, Cristina Pérez-López, Ascensión Peña-Cortijo, Marta Polo Zarzuela, Laura Gutiérrez, Rafael Martínez-Martínez
  • María del Carmen Vicente-Ayuso
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos; Department of Hematology, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain | mentxu888@gmail.com
  • María García-Roa
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos; Department of Hematology, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
  • Ataúlfo González-Fernández
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos; Department of Hematology, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
  • Ana María Alvarez-Carmona
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain
  • Celina Benavente-Cuesta
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain
  • Marta Mateo-Morales
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain
  • Cristina Pérez-López
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain
  • Ascensión Peña-Cortijo
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain
  • Marta Polo Zarzuela
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain
  • Laura Gutiérrez http://orcid.org/0000-0001-8443-900X
    Department of Hematology, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
  • Rafael Martínez-Martínez
    Servicio de Hematología y Hemoterapia, Hospital Clínico San Carlos, Madrid, Spain

Abstract

Acute promyelocytic leukemia (APL) has become a highly curable malignant disease after the introduction of all transretinoic acid (ATRA) to chemotherapy treatment. However, the risk to develop therapy-related myeloid neoplasms (t-MN) has become a matter of concern, as APL patients are otherwise expected to have a good prognosis. We report a patient with APL who achieved complete remission after chemotherapy induction with anthracycline and ATRA, followed by consolidation and maintenance chemotherapy. Two years later, the patient developed t-AML, with MLL rearrangements, without any evidence of relapse of the APL original clone. The increasing incidence of t-MN in oncohematological patients is partly due to the development of safer, more efficient or targeted therapies, which allow better outcomes and lengthened survival amongst treated patients. The identification of genetic factors, mechanisms or prognostic biomarkers in t-MN might open new windows for the development of personalized targeted therapy regimes in this underserved patient population.

Keywords

Acute promyelocytic leukemia, therapy-related myeloid neoplasms, therapyrelated acute myeloid leukemia

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Submitted: 2017-04-28 19:54:48
Published: 2017-09-27 07:40:15
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Copyright (c) 2017 María del Carmen Vicente-Ayuso, María García-Roa, Ataúlfo González-Fernández, Ana María Alvarez-Carmona, Celina Benavente-Cuesta, Marta Mateo-Morales, Cristina Pérez-López, Ascensión Peña-Cortijo, Marta Polo Zarzuela, Laura Gutiérrez, Rafael Martínez-Martínez

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