Very Early Onset of Therapy-Related Acute Myeloid Leukemia with 11q23 Rearrangement Presenting with Unusual PET Findings after R-DA-EPOCH for Primary Mediastinal Large B-Cell Lymphoma
Chrysovalantou Chatzidimitriou,
Phivi Rondogianni,
Maria Arapaki,
Athanasios Liaskas,
Eleni Plata,
Maria K. Angelopoulou,
Panagiotis Tsirigotis,
Theodoros P. Vassilakopoulos
Affiliations
Chrysovalantou Chatzidimitriou
Department of Haematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
Phivi Rondogianni
Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, 10676 Athens, Greece
Maria Arapaki
Department of Haematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
Athanasios Liaskas
Department of Haematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
Eleni Plata
Department of Haematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
Maria K. Angelopoulou
Department of Haematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
Panagiotis Tsirigotis
Second Department of Internal Medicine, Propaedeutic, School of Medicine, National and Kapodistrian University of Athens, Attikon General Hospital, 12462 Athens, Greece
Theodoros P. Vassilakopoulos
Department of Haematology and Bone Marrow Transplantation, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
Background: R-DA-EPOCH is an effective regimen for PMLBCL, which permits the omission of consolidative radiotherapy in the majority of patients. Patient: We describe a 27-year-old female patient, who achieved a complete remission after treatment with six cycles of R-DA-EPOCH (up to the final level). At 6 months after the end of treatment, PET/CT revealed an unexpected, diffusely increased 18FDG uptake by the bone marrow. Simultaneously, pancytopenia with monocytosis was observed. Result: The patient was diagnosed with therapy-related myelodysplastic syndrome, which rapidly evolved into acute myeloid leukemia (t-MDS/AML) with MLL rearrangements. She achieved a complete remission after induction therapy, received an allogenic transplant and remains disease-free 2 years later. Conclusions: The extremely early onset of t-MDS/AML, together with the unexpected PET/CT findings make this case unique and highlights the need for the accurate estimation of the possible dose-dependent risk of t-MDS/AML after R-DA-EPOCH in the real-life setting in patients with PMLBCL.
