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Treatment-related acute myeloid leukaemia : case report An approximately 47-year-old woman developed treatment-related acute myeloid leukaemia (t-AML) during chemotherapy with capecitabine and temozolomide for metastatic neuroendocrine tumor (NET). The woman presented with right hip pain. Based on the imaging and a biopsy, she was diagnosed with NET with widespread osseous metastases at the age of 42 years. Subsequently, she received a course of palliative radiation therapy (RT) on the right hip and was started on SC octreotide depot every 4 weeks. Her disease remained stable for the next 3 years, after which she developed progression in the axial skeleton requiring more courses of RT. She also developed progressive disease in the left breast as well as the ovary for which she underwent a palliative oophorectomy. Then, in January 2014, she was started on systemic chemotherapy with a combination of capecitabine 750 mg/m2 twice daily (days 1–14) and temozolomide 200 mg/m2 once daily (days 10–14) of a 28-day cycle (CAPTEM) [routes not stated]. Thereafter, her disease was stable for the next 2 years, but due to increasing fatigue, her temozolomide was eventually discontinued in March 2016. She had received a total temozolomide dose of 27,000 mg/m2. However, she remained on maintenance therapy with capecitabine alone for about 2 months, after which she was admitted with a fever and new pancytopenia. She also tested positive for influenza B, but improved with a course of oseltamivir. However, her pancytopenia persisted and fevers recurred despite holding chemotherapy. Two weeks later, a flow cytometry performed on the peripheral blood revealed 6% circulating myeloblasts expressing CD13, CD15, CD33, CD117, CD11c, dim CD34, and partial HLADR and CD4. A biopsy and bone marrow aspirate demonstrated 63% myeloblasts, consistent with t-AML. Subsequently, cytogenetic analysis revealed a gene abnormality 46XX,inv(16)(p13.1,q22) [16]/46 XX[4]. The woman’s capecitabine was permanently discontinued and she was treated with induction chemotherapy with cytarabine and daunorubicin for AML after which she achieved a complete remission (CR). Her most recent surveillance CT scan indicated that her metastatic NET was stable. Joseph R, et al. Inversion 16 (inv(16)) acute myeloid leukemia (AML) following treatment with radiation, capecitabine, and temozolomide in a patient with metastatic 803505194 neuroendocrine tumor (NET). Leukemia and Lymphoma 60: 2793-2797, No. 11, Nov 2019. Available from: URL: http://doi.org/10.1080/10428194.2019.1612060

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