Secondary acute myeloid leukemia after successful treatment of acute promyelocytic leukemia

Abstract

Clonal aberrations, leading to development of therapy-related myelodysplastic syndromes and secondary acute myeloid leukemias (s-AML), are present in 10% of patients treated previously for acute promyelocytic leukemia (APL). Most of them, especially monosomy 7, are associated with extremely poor prognosis. We present a case of 22-years-old female patient with APL diagnosed in 2008 who achieved complete cytogenetic and molecular remission after treatment according to PETHEMA protocol. Two years after the treatment was completed, s-AML with complex monosomal karyotype including monosomy 7 and t(3;21)(q26.2;q22) was diagnosed. Complete cytogenetic remission was achieved after 2 induction cycles and finally the allogeneic hematopoietic stem cell transplantation from HLA-matched related donor was performed. In the posttransplant period moderate chronic graft versus host disease was observed. Now, 15 months after transplantation, the patient is still in complete cytogenetic remission with 100% of donor chimerism. Presented case demonstrates diagnostic and therapeutic dilemma of s-AML in a patient with complete remission of APL.