Therapy-Related Pure Erythroid Leukaemia with Complex Karyotype Following Successful Treatment for Acute Promyelocytic L
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CORRESPONDENCE
Therapy-Related Pure Erythroid Leukaemia with Complex Karyotype Following Successful Treatment for Acute Promyelocytic Leukaemia Guiying Li1 • Keyu Liu2
•
Jing Zhang1 • Nan Wang4 • Yanfang Yu3
Received: 26 June 2020 / Accepted: 19 August 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
Dear Editor, In the 2017 revision of the WHO classification therapyrelated myeloid neoplasms (t-MNs) include those cases of therapy-related acute myeloid leukaemia (t-AML), therapy-related myelodysplastic syndromes(t-MDS), and therapy-related myelodysplastic/myeloproliferative neoplasms (t-MDS/MPN) that develop as a late-occurring complication of chemotherapy and/or radiation treatment on account of previous iatrogenic exposure of mutagenic agents [1]. Several cases of t-MNs after successful treatment for APL with ATRA and anthracycline have been reported [2–7]. However, pure erythroid leukaemia is extremely rare, and this is the first case of therapy-related pure erythroid leukaemia with very complex karyotype after successful treatment for acute promyelocytic leukaemia (APL) with t (15;17) due to anthracyclines as potential leukaemogenic drugs. In January 2018, A 24-year-old woman presented with haemorrhagic syndrome and pancytopenia. Laboratory findings were as follows: White blood cell count was
& Keyu Liu [email protected] 1
Department of Clinical Laboratory, Inner Mongolia Xingan League People’s Hospital, the Inner Mongolia Autonomous Region, China
2
Department of Clinical Laboratory, Affiliated Hospital of Engineering University of Hebei, Handan, Hebei Province, China
3
Department of Hematology, Affiliated Hospital of Engineering University of Hebei, Handan, Hebei Province, China
4
Department of Internal Medicine, Handan People’s Hospital, Handan, Hebei Province, China
2.39 9 109/L, hemoglobin was 90 g/L, platelet count was 6 9 109/L, fibrinogen was 3.41 g/l and D-dimer was 3.25 mg/l. An acute promyelocytic leukaemia was diagnosed based on 81% abnormal promyelocytes in the bone marrow, positive PML-RARA fusion gene, and karyotype: 46, XX, t (15;17)(q24;q21). We did not find any myelodysplastic change. The patient was treated with arsenic trioxide (ATO) and retinoic acid-based regimen and CR was achieved after 40 days. Daunorubicin and cytarabine were administered for consolidation. In March 2020, 26 months after achieving molecular remission, the patient sought medical attention for persistent fever and pancytopenia. Bone marrow smears indicated 82% of the nucleated cells were erythroid cells with 31% proerythroblasts (Fig. 1a,b), which were positive for Periodic Acid Schiff staining (Fig. 1c). Immunophenotyping of BM showed 29.28% abnormal cells, which were positive for CD36, CD71 and CD34(partial), and negative for CD13, CD33, CD64, CD15, CD14, CD41 and CD61. A few cells were positive for HLA-DR and CD117 (Fig. 2). Cytogenetic analysis indicated 45,XX,del(5)(q15q33), der(17) t (17;21) (p11.2;q11.2),del(20)(q11.2),-21[16]/ 44,XX,del(3)(q21),-4,del(5) (q15q33),del(6)(q15), ? add(8)(
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