Secondary Acute Myeloid Leukemia M6 after Treatment of Non-Hodgkin’s Lymphoma: A Report of One Case_West China Medical Journal

Authors：

ZHANG Yanling ¹ , HE Sen ² , MOU Yi ³ , YANG Yang ⁴ , BAN Chengzhe ⁵ ,  WU Yu ¹

1. Department of Hematology, West China Hospital; 2. Department of Cardiology, West China Hospital; 3. Department of Digestive System, West China Hospital; 4. Clinical Medical School; 5. School of Stomatology; Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WU Yu, Email: xiaozhangyaner@126.com

Keywords：

治疗相关性白血病; 非霍奇金淋巴瘤; 急性髓细胞白血病M6型

DOI：

CNKI: 51-1356/R.20120115.1541.003

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目的　增加对治疗相关性继发白血病的认识。方法　报道非霍奇金淋巴瘤治疗后2年继发急性髓细胞白血病M6型1例，结合文献讨论治疗相关性白血病的发病机制、治疗、预后。结果　1例73岁非霍奇金淋巴瘤患者接受R（Rituxmab，利妥昔单抗）－CHOP环磷酰胺+多柔比星+长春新碱+泼尼松方案规律化学治疗。治疗结束24+个月后，经骨髓涂片及细胞免疫分型诊断为急性髓细胞白血病M6型，染色体检查为：44～48，XY，del（5）（q12q33），-8，-10，der（12）t（4；12）（q11-q12；p13），其一般情况急剧恶化并死亡。结论　治疗相关性白血病的发生可能与烷化剂等化疗药物使用和免疫受损等有关，利妥昔单抗导致第二肿瘤的发生暂时不能除外。治疗相关性白血病常伴有复杂染色体核型，其病情发展迅速，治疗效果差，生存期明显缩短。
Objective 　To improve the understanding of secondary therapy-related leukemia. Methods 　The clinical data of one patient with non-Hodgkin lymphoma which transformed into acute myeloid leukemia M6 2 years after chemotherapy were studied. We discussed the pathogenesis, treatment and prognosis of therapy-related leukemia with literature review. Results 　A 73-year-old patient diagnosed to have non-Hodgkin’s lymphoma accepted R-CHOP chemotherapy.Two years after the treatment, the disease finally developed into acute myeloid leukemia M6 confirmed by cytogenetics, bone marrow morphology and flowcytometry analysis. The chromosome analysis demonstrated complex karyotypes as 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13). His general status deteriorated rapidly and soon after the patient died. Conclusions 　Occurrence of therapy-related leukemia may be due to the administration of alkylating agents, topoisomerase inhibitors and damage of immune function. Therapy-related leukemia often occurs with complex karyotypes and progresses rapidly with poor treatment response.

Citation： ZHANG Yanling,HE Sen,MOU Yi,YANG Yang,BAN Chengzhe,WU Yu. Secondary Acute Myeloid Leukemia M6 after Treatment of Non-Hodgkin’s Lymphoma: A Report of One Case. West China Medical Journal, 2012, 27(1): 14-17. doi: CNKI: 51-1356/R.20120115.1541.003 Copy

1.	Armitage JO, Carbone PP, Connors JM, et al. Treatment-related myelodysplasia and acute leukemia in non-Hodgkin’s lymphoma patients[J]. J Clin Oncol, 2003, 21(5): 897-906.
2.	Sacchi S, Marcheselli L, Bari A, et al, Secondary malignancies after treatment for indolent non-Hodgkin’s lymphoma, a 16-year follow-up study[J]. Hematologica, 2008, 93(3): 398-404.
3.	Gomez GA, Friedman M, Reese P. Occurrence of acute nonlymphocytic leukemia in a prospective randomized study of treatment for Hodgkin’s disease[J]. Am J Clin Oncol, 1983, 6(3): 319-323.
4.	Karp JE, Sarkodee-Adoo CB. Therapy-related acute leukemia[J]. Clin Lab Med, 2000, 20(1): 71-81.
5.	Swerdlow, SH, Campo, E, Harris, NL, et al. World Health Organization classification of tumours of haematopoietic and lymphoid tissues[M]. Lyon: IARC Press, 2008: 127-129.
6.	Pagano L , Pulsoni A , Tosti ME , et al. Acute lymphoblastic leukemia occurring as second malignancy: report of the GIMEMA archive of adult acute leukemia[J]. Br J Haematol, 1999, 106(4):.
7.	Ram R, Bonstein L, Gafter-Gvili A, et al. Rituximab-associated acute thrombocytopenia: an under-diagnosed phenomenon[J]. Am J Hematol, 2009, 84(4): 247-250.
8.	Hijiya N, Ness KK, Ribeiro RC. Acute leukemia as a secondary malignancy in children and adolescents: current findings and issues[J]. Cancer, 2009, 115(1): 23-35.
9.	于虹, 付蓉, 阮二宝, 等. 急性非淋巴细胞白血病合并非霍奇金淋巴瘤3例报道[J]. 中国实用内科杂志, 2010, 30(12): 1131-1132.
10.	Schoch C, Kern W, Schnittger S, et al. Karyotype is an independent prognostic parameter in therapy-related acute myeloid leukemia (t-AML): an analysis of 93 patients with t-AML in comparison to 1091 patients with de novo AML[J]. Leukemia, 2004, 18(1): 120.
11.	Rowley JD, Alimena G, Carson OM, et al. A collaborative study of the relationship of the morphologyic type of acute nonlymphocytic leukemia with patient age and karyotype[J]. Blood, 1982, 59(5): 1013-1022.
12.	Takeyama K, Seto M, Uike N, et al. Therapy-related leukemia and myelodysplastic syndrome: a large-scale Japanese study of clinical and cytognetic features as well as prognostic factors[J]. Int J Hematol, 2000, 71(2): 144-152.
13.	McLaughlin P, Estey E, Glassman A, et al. Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma with fludarabine, mitoxantrone, and dexamethasone (FND) plus rituximab and interferon alpha[J]. Blood, 2005, 105: 4573-4575.
14.	Martin-Salces M, Canales MA, de Paz R, et al. Treatment-related acute myeloid leukemia with 11q23 translocation following treatment with fludarabine, cyclophosphamide and rituximab[J]. Leuk Res, 2008, 32(1): 199-220.
15.	Larson RA. Therapy-related myeloid neoplasms[J]. Haematlogica, 2009, 94(4): 454-459 .
16.	Hoyle CF, de Bastos M, Wheatley K, et al. AML associated with previous cytotoxic therapy, MDS or myeloproliferative disorders: results from the MRC’s 9th AML trial[J]. Br J haematol, 1989, 72(1): 45-53.
17.	展昭民, 陈德发, 吴红举, 等, 治疗相关性白血病的治疗[J]. 癌症进展杂志, 2005, 3(2): 106-108.
18.	Ng A, Taylor GM, Eden OB. Treatment-related leukemia: a clinical and scientific challenge[J]. Cancer Treat Rev, 2000, 26(5): 377-391.
19.	Kroger N, Brand R, van Biezen A, et al. Autologous stem cell transplantation for therapy-related acute myeloid leukemia and myelodysplastic syndrome[J]. Bone Marrow Transplant, 2006, 37(2): 183-189.
20.	-1040.

1. 　Armitage JO, Carbone PP, Connors JM, et al. Treatment-related myelodysplasia and acute leukemia in non-Hodgkin’s lymphoma patients[J]. J Clin Oncol, 2003, 21(5): 897-906.
2. 　Sacchi S, Marcheselli L, Bari A, et al, Secondary malignancies after treatment for indolent non-Hodgkin’s lymphoma, a 16-year follow-up study[J]. Hematologica, 2008, 93(3): 398-404.
3. 　Gomez GA, Friedman M, Reese P. Occurrence of acute nonlymphocytic leukemia in a prospective randomized study of treatment for Hodgkin’s disease[J]. Am J Clin Oncol, 1983, 6(3): 319-323.
4. 　Karp JE, Sarkodee-Adoo CB. Therapy-related acute leukemia[J]. Clin Lab Med, 2000, 20(1): 71-81.
5. 　Swerdlow, SH, Campo, E, Harris, NL, et al. World Health Organization classification of tumours of haematopoietic and lymphoid tissues[M]. Lyon: IARC Press, 2008: 127-129.
6. 　Pagano L , Pulsoni A , Tosti ME , et al. Acute lymphoblastic leukemia occurring as second malignancy: report of the GIMEMA archive of adult acute leukemia[J]. Br J Haematol, 1999, 106(4):.
7. 　Ram R, Bonstein L, Gafter-Gvili A, et al. Rituximab-associated acute thrombocytopenia: an under-diagnosed phenomenon[J]. Am J Hematol, 2009, 84(4): 247-250.
8. 　Hijiya N, Ness KK, Ribeiro RC. Acute leukemia as a secondary malignancy in children and adolescents: current findings and issues[J]. Cancer, 2009, 115(1): 23-35.
9. 　于虹, 付蓉, 阮二宝, 等. 急性非淋巴细胞白血病合并非霍奇金淋巴瘤3例报道[J]. 中国实用内科杂志, 2010, 30(12): 1131-1132.
10. 　Schoch C, Kern W, Schnittger S, et al. Karyotype is an independent prognostic parameter in therapy-related acute myeloid leukemia (t-AML): an analysis of 93 patients with t-AML in comparison to 1091 patients with de novo AML[J]. Leukemia, 2004, 18(1): 120.
11. 　Rowley JD, Alimena G, Carson OM, et al. A collaborative study of the relationship of the morphologyic type of acute nonlymphocytic leukemia with patient age and karyotype[J]. Blood, 1982, 59(5): 1013-1022.
12. 　Takeyama K, Seto M, Uike N, et al. Therapy-related leukemia and myelodysplastic syndrome: a large-scale Japanese study of clinical and cytognetic features as well as prognostic factors[J]. Int J Hematol, 2000, 71(2): 144-152.
13. 　McLaughlin P, Estey E, Glassman A, et al. Myelodysplasia and acute myeloid leukemia following therapy for indolent lymphoma with fludarabine, mitoxantrone, and dexamethasone (FND) plus rituximab and interferon alpha[J]. Blood, 2005, 105: 4573-4575.
14. 　Martin-Salces M, Canales MA, de Paz R, et al. Treatment-related acute myeloid leukemia with 11q23 translocation following treatment with fludarabine, cyclophosphamide and rituximab[J]. Leuk Res, 2008, 32(1): 199-220.
15. 　Larson RA. Therapy-related myeloid neoplasms[J]. Haematlogica, 2009, 94(4): 454-459 .
16. 　Hoyle CF, de Bastos M, Wheatley K, et al. AML associated with previous cytotoxic therapy, MDS or myeloproliferative disorders: results from the MRC’s 9th AML trial[J]. Br J haematol, 1989, 72(1): 45-53.
17. 　展昭民, 陈德发, 吴红举, 等, 治疗相关性白血病的治疗[J]. 癌症进展杂志, 2005, 3(2): 106-108.
18. 　Ng A, Taylor GM, Eden OB. Treatment-related leukemia: a clinical and scientific challenge[J]. Cancer Treat Rev, 2000, 26(5): 377-391.
19. 　Kroger N, Brand R, van Biezen A, et al. Autologous stem cell transplantation for therapy-related acute myeloid leukemia and myelodysplastic syndrome[J]. Bone Marrow Transplant, 2006, 37(2): 183-189.
20. -1040.

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West China Medical Journal

Secondary Acute Myeloid Leukemia M6 after Treatment of Non-Hodgkin’s Lymphoma: A Report of One Case

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