Two cases of therapy-related acute promyelocytic leukemia (t-APL) after mantle cell lymphoma and gestational trophoblastic disease

Ann Hematol. 2002 Nov;81(11):659-61. doi: 10.1007/s00277-002-0552-6. Epub 2002 Nov 6.

Abstract

We report two cases of secondary acute promyelocytic leukemia (APL). One patient presented with concurrent APL and missed abortion 1 year after etoposide-based chemotherapy for gestational trophoblastic disease. A prolonged complete remission was achieved with standard chemotherapy. An elderly man developed APL 1 year after alkylator-based chemotherapy for mantle cell lymphoma (MCL). A complete clinical and molecular remission was obtained with chemotherapy and all- trans retinoic acid, followed by arsenic consolidation. Concomitant molecular relapse of APL and MCL clones was detected at 1 year, both of which responded to oral arsenic therapy. High-dose epipodophyllin is a dose risk for secondary APL, but alkylating agents may also be implicated. For patients with a history of active malignancy and heavy previous chemotherapy exposure, the use of nontoxic arsenic therapy appeared to be effective and prudent.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Alkylating / adverse effects
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Arsenic Trioxide
  • Arsenicals / therapeutic use*
  • Etoposide / adverse effects
  • Etoposide / therapeutic use
  • Female
  • Gestational Trophoblastic Disease / drug therapy*
  • Gestational Trophoblastic Disease / pathology
  • Humans
  • Leukemia, Promyelocytic, Acute / chemically induced
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Leukemia, Promyelocytic, Acute / etiology
  • Lymphoma, Mantle-Cell / drug therapy*
  • Lymphoma, Mantle-Cell / pathology
  • Male
  • Neoplasms, Second Primary / drug therapy*
  • Neoplasms, Second Primary / etiology
  • Oxides / therapeutic use*
  • Pregnancy
  • Tretinoin / therapeutic use

Substances

  • Antineoplastic Agents, Alkylating
  • Arsenicals
  • Oxides
  • Tretinoin
  • Etoposide
  • Arsenic Trioxide