Therapy-Related Myeloid Leukemia

Department of Medicine and Cancer Research Center, University of Chicago, Chicago, IL 60637, USA. <>
Seminars in Oncology (Impact Factor: 3.9). 09/2008; 35(4):418-29. DOI: 10.1053/j.seminoncol.2008.04.012
Source: PubMed


Therapy-related myelodysplastic syndrome and acute myeloid leukemia (t-MDS/t-AML) are thought to be the direct consequence of mutational events induced by chemotherapy, radiation therapy, immunosuppressive therapy, or a combination of these modalities, given for a pre-existing condition. The outcomes for these patients have been poor historically compared to people who develop de novo AML. The spectrum of cytogenetic abnormalities in t-AML is similar to de novo AML, but the frequency of unfavorable cytogenetics, such as a complex karyotype or deletion or loss of chromosomes 5 and/or 7, is considerably higher in t-AML. Survival varies according to cytogenetic risk group in t-AML patients, with better outcomes being observed in those with favorable-risk karyotypes. Treatment recommendations should be based on performance status and karyotype. A deeper understanding of the factors that predispose patients to the development of therapy-related myeloid leukemia would help clinicians monitor patients more carefully after treatment for a primary condition. Ultimately, this knowledge could influence initial treatment strategies with the goal of decreasing the incidence of this serious complication.

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    • "T-MDS is also occasionally found after treatment with topoisomerase II inhibitors, but more commonly the patient presents with full-blown AML after a latency period of just 1 to 3 years. Topoisomerase II inhibitors are associated with translocations involving chromosome bands 11q23 or 21q22.9) "
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    ABSTRACT: Myelodysplastic syndromes (MDS) are probably the most common hematologic malignancies in adults over the age of 60 and are a major source of morbidity and mortality among older age groups. Diagnosis and management of this chronic blood cancer has evolved significantly in recent years and there are Food and Drug Administration-approved therapies that can extend patients' life expectancy and improve quality of life. Primary care physicians (PCPs) are often involved in the process of diagnosis and follow-up of MDS patients, especially those in low-risk groups. They can therefore play an important role in improving patient care and quality of life by ensuring early referral and participating in supportive management. There is also a shortage of oncologists which increases the importance of the role of PCPs in management of MDS patients. In the face of limited resources, PCPs can improve access and quality of care in MDS patients. This article provides an overview of the common manifestations, diagnostic approaches, and therapeutic modalities of MDS for PCPs, with a focus on when to suspect MDS, when a referral is appropriate, and how to provide appropriate supportive care for patients diagnosed with MDS.
    Korean Journal of Family Medicine 05/2014; 35(3):111-118. DOI:10.4082/kjfm.2014.35.3.111
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    • "Non-Hodgkin lymphoma is the most common malignancy that occurs after solid organ transplantation [3] [4], but t-MN has also been described [5] [6] [7] [8]. T-MN generally portends a poor prognosis despite treatment with induction chemotherapy and, more recently, allo-HCT [9]. Treatment of t-MN in solid organ transplant recipients is even more challenging as these patients require ongoing immunosuppression and often have multiple co-morbidities. "
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    ABSTRACT: Therapy-related myeloid neoplasm (t-MN) is a subtype of acute myeloid leukemia with adverse cytogenetics and poor overall prognosis despite intensive induction chemotherapy and allogeneic hematopoietic cell transplantation (allo-HCT). It is increasingly recognized as a late complication of chronic immunosuppression in patients who have received solid organ transplantation. In this paper, we describe a case of t-MN following orthotopic cardiac transplantation and its treatment with allo-HCT. We discuss molecular and biological challenges and considerations in double solid organ and bone marrow transplantation and review similar cases at our institution. Our experience suggests general feasibility and safety of allo-HCT in patients who have received solid organ transplantation.
    03/2013; 2013:140138. DOI:10.1155/2013/140138
    • "Therapy-related acute myeloid leukemia (t-AML) represents one of the most severe late-effects after treatment for HL. Treatment for a pre-existing condition using CT, radiation or immunosuppressive therapy, or a combination of these may lead to the devastating complication of t-AML.[7] Although a causal relationship is implied, the mechanism remains to be proven. "
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    ABSTRACT: Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.
    Journal of Indian Society of Periodontology 03/2013; 17(2):248-52. DOI:10.4103/0972-124X.113090
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