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Blood, 1 February 2002, Vol. 99, No. 3, pp. 822-824
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Therapy-related myelodysplastic syndrome–acute
myelogenous leukemia in patients treated for acute promyelocytic
leukemia: an emerging problem
Roberto Latagliata,
Maria
Concetta Petti,
Susanna Fenu,
Marco Mancini,
Maria Antonietta Aloe Spiriti,
Massimo Breccia,
Gregorio
A. Brunetti,
Giuseppe Avvisati,
Francesco Lo Coco, and
Franco Mandelli
From the Department of Human Biotechnologies and
Hematology, University La Sapienza of Roma, and Ematologia Istituto
Regina Elena, IFO, Rome, Italy.
The use of all-trans retinoic acid (ATRA) in
combination with chemotherapy has markedly improved the prognosis for
patients with acute promyelocytic leukemia (APL); the higher complete
remission (CR) and survival rates now reported in this disease almost
approach those obtained for other highly curable hematologic
malignancies. Of 77 patients with APL who were consecutively treated at
a single institution and who achieved CR after induction and
consolidation therapy, 5 (6.5%) acquired therapy-related
myelodysplasia (tMDS), acute myelogenous leukemia (AML), or both
(tMDS-AML). Of these, 3 of 46 (6.5%) patients received front-line
chemotherapy with or without ATRA and acquired tMDS-AML while in first
remission of APL. Two underwent repeated chemotherapy cycles with ATRA
because of APL relapse and acquired tMDS-AML while in the second
or third remission of APL. In 2 patients, clinical and biologic
characteristics of tMDS-AML were as expected for postalkylating forms
(long latency, MDS phase preceding AML, karyotypic aberrations
involving chromosomes 5 or 7), even though one of them had not
previously received alkylating drugs. Three of the 5 patients died
shortly after tMDS-AML diagnosis, one is alive with tMDS, and one is
alive and in CR after allogeneic bone marrow transplantation. The
occurrence of tMDS-AML after successful therapy for APL is an emerging
problem. The availability of prognostic score systems at initial
diagnosis and monitoring of residual disease by polymerase chain
reaction might allow better tailoring of treatment intensity in APL to
spare unnecessary toxicity and to minimize the risk for tMDS-AML in
patients who are presumably cured.
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