Journal of Leukemia
Open Access

Abstract

Secondary Acute Myeloid Leukemia (sAML) Immediately after Intensive Chemotherapy of Acute Lymphoblastic Leukemia (ALL)

Sebastian Grosicki, Agnieszka Barchnicka, Ewa Bodzenta, Olga Haus and Anna Jaśkowiec

A 20-year-old woman was admitted to our unit, because of pre-B acute lymphoblastic leukemia (ALL). Classical cytogenetics revealed a normal karyotype. In FISH analysis no TEL-AML1 fusion, rearranged MLL gene, or BCRABL were found. The induction and consolidation chemotherapy was conducted according to protocol PALG 5-2007. In the assessment of minimal residual disease using flow cytometry after consolidation 0.02% of the baseline phenotype of lymphoblasts were found. After two weeks of the completion of intensive chemotherapy, the patient was admitted in emergency to hematology inpatient unit, because of secondary acute myeloid leukemia (sAML). The conventional cytogenetic karyotype was complex: 46, XX, der (7) t (5;7;10;?)del(7)(q22), t(11;17)(p11;q21),del(14)(q24q32). After the diagnosis of sAML, induction chemotherapy was given according to the program PALG DAC: cytarabine 329 mg/d 1-7, daunorubicin 90 mg iv/d 1-3, cladribine 8 mg/d 1-5. The patient died due to progression of refractory leukemia in 45 days. The risk of developing of the sAML after treatment of ALL in adults is about 0.5-1% after few years. Our case was unique, because sAML developed rapidly, just after five months of ALL diagnosis, three months after CR1 and two weeks after completion of consolidation chemotherapy.