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Molica M, Mazzone C, Ottone T, Niscola P, Abruzzese E, Fratoni S, Voso MT, de Fabritiis P. Case Report: Very Late, Atypical Extra-Medullary Relapse in a Patient With Acute Promyelocytic Leukemia (APL) Rescued With a Transplant-Free Approach. Front Oncol 2021; 11:699886. [PMID: 34268125 PMCID: PMC8276173 DOI: 10.3389/fonc.2021.699886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/11/2021] [Indexed: 12/01/2022] Open
Abstract
Relapses of acute promyelocytic leukemia (APL) beyond 7 years from the first molecular remission are exceptional, and it is unclear whether these relapses represent a new, therapy-related leukemia rather than a delayed relapse of the original leukemic clone. The increase extra-medullary relapses (ER) in the era of all-trans retinoic acid (ATRA) therapy suggests a potential correlation between ATRA therapy and ER, and several potential explanations have been proposed. The gold standard post-remission approach, particularly for patients in late relapse, has not yet been established. The benefit of a transplant approach has been questioned in this setting because continuing ATRA-arsenic trioxide (ATO) might be curative. Here we report on the case of an APL patient who relapsed 9 years after achieving her first molecular complete remission (mCR) and who showed an atypical isolated localization at nodal sites, including the into- and peri-parotid glands. Genomic PML/RARa breakpoint analysis detected the same bcr3 PML/RARa hybrid gene in DNA purified from bone marrow and lymph nodes, suggesting that the relapse was because of the reemergence of the initial clone. This case shows that APL, treated with ATRA and cytotoxic drugs, may still emerge in extra-medullary sites even after a very prolonged mCR and could be salvaged with an ATO-based protocol, not including a transplant approach.
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Affiliation(s)
| | | | - Tiziana Ottone
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | | | | | - Stefano Fratoni
- Surgical Pathology, Hematopathology Unit, St. Eugenio Hospital, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Paolo de Fabritiis
- Haematology Unit, St. Eugenio Hospital, Rome, Italy
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
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Sakurai M, Watanuki S, Kato J, Hashida R, Yamane Y, Karigane D, Mitsuhashi T, Murata M, Ueno H, Nakazato T, Okamoto S, Mori T. Very Late Relapse of Acute Promyelocytic Leukemia 17 Years after Continuous Remission. Intern Med 2018; 57:3299-3302. [PMID: 29984744 PMCID: PMC6287980 DOI: 10.2169/internalmedicine.0807-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The prognosis of acute promyelocytic leukemia (APL) has been improved by the combination of all-trans retinoic acid (ATRA) with chemotherapy. Nonetheless, relapse occurs in a certain proportion of patients, mostly within three to four years after treatment. We herein report a patient treated with ATRA and chemotherapy achieving remission who relapsed approximately 17 years after the treatment. A literature review identified 5 additional reported cases of APL relapse after more than 10 years. None of them presented with generally established risk factors for relapse, such as a high leukocyte count. The potential for late relapse of APL occurring more than 10 years after treatment should be recognized.
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Affiliation(s)
- Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Shintaro Watanuki
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Jun Kato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Risa Hashida
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Yusuke Yamane
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Daiki Karigane
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | | | - Mitsuru Murata
- Laboratory Medicine, Keio University School of Medicine, Japan
| | - Hironori Ueno
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Division of Hematology, Department of Internal Medicine, National Hospital Organization, Tokyo Medical Center, Japan
| | - Tomonori Nakazato
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
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Testi AM, Moleti ML, Canichella M, Mohamed S, Diverio D, de Propris MS, Locatelli F, Lo Coco F, Foà R. Very late relapse in a patient with acute promyelocytic leukemia (APL) rescued with a chemotherapy-free protocol. Leuk Lymphoma 2016; 58:999-1001. [DOI: 10.1080/10428194.2016.1222377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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4
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Abla O, Kutny MA, Testi AM, Feusner JH, Creutzig U, Gregory J, Gibson B, Leverger G, Ribeiro RC, Smith O, Locatelli F, Kaspers G. Management of relapsed and refractory childhood acute promyelocytic leukaemia: recommendations from an international expert panel. Br J Haematol 2016; 175:588-601. [PMID: 27651168 DOI: 10.1111/bjh.14313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Matthew A Kutny
- Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anna Maria Testi
- Department of Cellular Biotechnologies and Haematology, Sapienza University of Rome, Rome, Italy
| | - James H Feusner
- Division of Hematology/Oncology, Children's Hospital and Research Center Oakland, Oakland, CA, USA
| | - Ursula Creutzig
- Paediatric Haematology/Oncology, Hannover Medical School, Hannover, Germany
| | - John Gregory
- Atlantic Health System, Goryeb Children's Hospital, Morristown, NJ, USA
| | - Brenda Gibson
- Department of Haematology and Oncology, Royal Hospital for Children, Glasgow, UK
| | - Guy Leverger
- Haematology/Oncology, Hôpital Armand Trousseau, Paris, France
| | - Raul C Ribeiro
- Department of Oncology, Division of Leukemia/Lymphoma, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Owen Smith
- Department of Haematology/Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Franco Locatelli
- Department of Paediatric Haematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.,University of Pavia, Pavia, Italy
| | - Gertjan Kaspers
- Paediatric Oncology, VU University Medical Centre, Amsterdam, The Netherlands.,Academy of Princess Máxima Centre for Paediatric Oncology, Utrecht, The Netherlands
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5
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Kim MJ, Cho SY, Lee HJ, Suh JT, Lee WI, Lee J, Baek SK, Yoon HJ, Park TS. Late Relapse of Acute Promyelocytic Leukemia: Literature Review and Results of Seven Years of Clinical and Laboratory Follow-Up of a Korean Patient. Lab Med 2012. [DOI: 10.1309/lmras7olkuxpuo4g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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6
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External auditory canal and middle ear relapse of acute promyelocytic leukemia treated with arsenic trioxide: case report and review of the literature. J Pediatr Hematol Oncol 2010; 32:229-32. [PMID: 20186102 DOI: 10.1097/mph.0b013e3181cf7ef3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extramedullary involvement occurs infrequently in acute promyelocytic leukemia and is said to be more common after treatment with all-trans retinoic acid. We describe a 9-year-old girl who had an isolated external auditory canal and middle ear relapse after treatment with all-trans retinoic acid and chemotherapy. A patient with cytogenetically and molecularly confirmed acute promyelocytic leukemia developed isolated extramedullary relapse in the auditory canal and middle ear 4 years and 9 months after initial diagnosis, while in hematologic and molecular remission, successfully treated with arsenic trioxide alone.
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Promyelocytic sarcoma of the spine: a case report and review of the literature. Adv Hematol 2010; 2010:137608. [PMID: 20339529 PMCID: PMC2843861 DOI: 10.1155/2010/137608] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 01/15/2010] [Indexed: 12/17/2022] Open
Abstract
Myeloid sarcoma (MS, previously named granulocytic sarcoma or chloroma) is a rare extramedullary tumour of immature myeloid cells. It can be present before, concurrently with, or after the diagnosis of acute myeloid leukemia. MS is extremely uncommon in acute promyelocytic leukemia (APL). In the case described here, MS was the sole site of APL relapse and the cause of spinal cord compression. The patient presented with neurologic symptoms due to a paravertebral mass of MS after 7 years of complete remission. He was treated with excision of the mass followed by local radiotherapy. Systemic treatment was also given with combined arsenic trioxide and all-trans retinoic acid and the patient was able to achieve a second prolonged clinical and molecular remission.
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Lee SH, Abebe L, Paietta E, Einzig A, Wiernik PH. Reappearance of acute myeloid leukemia after almost 23 years of continuous complete remission. Am J Hematol 2009; 84:455-7. [PMID: 19507211 DOI: 10.1002/ajh.21431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Current Awareness in Hematological Oncology. Hematol Oncol 2007. [DOI: 10.1002/hon.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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