Rapidly progressive therapy-related myeloid neoplasm in a patient treated for Burkitt lymphoma: A case report

Abstract

Therapy related myeloid neoplasm (t-MN) occurs as a late complication of cytotoxic agent chemotherapy for a prior malignancy. In the literature so far, only rare cases of a t-MN following Burkitt lymphoma (BL) chemotherapy have been reported.We present a case of a 44-year-old female who initially presented with Stage 4b, EBV-negative BL with classic morphological, immunophenotypic and cytogenetic features. The patient was treated with standard CODOX-M/IVAC chemotherapy (Cyclophosphamide, Doxorubicin, Vincristine, Methotrexate, Leucovorin, Ifosfamide, Etoposide, Cytarabine) plus Rituximab and achieved complete remission. She subsequently presented 2 years later with a t-MN which progressed to acute myeloid leukemia within 4 months.Fluorescence in situ hybridization studies (FISH) and cytogenetic studies post chemotherapy showed an abnormal mosaic female karyotype with ring chromosome 20 along with a structurally abnormal chromosome 21 including additional material of unknown origin added at band q22. KMT2A rearrangement was excluded by FISH. In addition, presence of a TP53 mutation was identified in the leukemia cell population by next generation sequencing. Keywords: Therapy related myeloid neoplasm, Burkitt lymphoma, Chemotherapy