| Objective: To analyze the clinical characteristics, treatment and prognosis of the patients with breast cancer therapy-related acute leukemia so as to improve the knowledge of this disease.Methods: Retrospectively analyzed 15 cases with breast cancer therapy-related acute leukemia who were treated at the First Affiliated Hospital of Guangxi Medical University between January 2003 and February 2015. The data included general characteristics, clinical presentations, laboratory results,treatment and prognosis. The data were calculated by SPSS17.0. The general laboratory results were showed as mean ± standard deviation.Results:1. Epidemiology and clinical presentations(1)All the 15 cases were female with median age of 46 years(37-66 years) andmedian incubation period(the period from the first time of radiotherapyand/or chemotherapy of breast cancer to the time of diagnosis of t-AL) of 5years(1.5-12 years). Among them, 1 case was diagnosed as therapy-relatedacute lymphoblastic leukemia(t-ALL) and 14 cases therapy-related acutemyeloid leukemia(t-AML). t-AL and t-AML accounted for 0.95% and1.40% respectively among all the newly diagnosed adult acute leukemia andacute myeloid leukemia patients at the same period in our hospital.(2)The histological type and radio-chemotherapy of breast cancer: invasiveductal carcinoma 6 cases, adenocarcinoma 5 cases, invasive lobularcarcinoma 3 cases, medullary carcinoma 1 case; radiotherapy alone 1 case,chemotherapy alone 9 cases and radio-chemotherapy 5 cases.(3)Clinical presentations: anemia 15 cases(100%), hemorrhage 10 cases(67%),infection 7 cases(47%) and infiltration 6 cases(40%).2. Laboratory results:(1)Blood for complete picture: WBC≥10×109/L 8 cases(≥100×109/L 2 cases),WBC<4×109/L 5 cases; HB<90g/L 9 cases; PLT≤50×109/L 12 cases(<20×109/L 3 cases). And dyshaematopoesis of bone marrow cells can befound commonly(53%).(2)FAB classification: t-AML 14 cases:M2 2 cases, M3 4 cases, M5 4 cases,M4 4 cases; 1case was t-ALL-L2.(3)Immunophenotype: Among the 11 cases, lymphoid expression(CD7+) wasseen in 4 cases of t-AML and lymphoid expression in t-ALL.(4)Cytogenetics: Chromosome testing was done in 10 cases: 46, XX, t(15;17)(q22; q21) 3 cases; 46, XX, t(8; 21)(q22; q22) 2 cases; 46, XX, t(4;11)(q21; q23) 1 case; normal chromosome karyotype 4 cases.(5)Molecular biology: Fusion gene testing was done in 10 cases: PML-RARα 3cases, AML1/ETO 2 cases, MLL 1 case, FLT3/ITD 1 case, CEBPA 1 case,negative 3 cases, NPM1 gene was not detected.3. Treatment and prognosis:(1)M3 type: Among 4 cases of M3, 1 case abandoned treatment, the other 3cases got complete remission(CR) after induction chemotherapy withretinoic acid and daunorubicin: 1 case was lost contact, 2 cases did notreceive consolidation therapy and died of disease recurrence.(2)The other 8 cases(t-AML other than M3) were induced with standardAnthracyclines+Cytarabine, HA(Homoharringtonine+Cytarabine) regimen.4 cases were CR(50%), 1 case was lost contact after CR, 1 case were died ofleukemia relapse after CR and 2 cases is still alive.(3)The one case of t-ALL was lost contact after getting CR with inductionchemotherapy.Conclusions1. In our study of the breast cancer therapy-related acute leukemia(t-AL), acutemyeloid leukemia(AML) was more common than acute lymphoblasticleukemia(ALL). There was no specific clinical symptoms, mostly presentingwith anemia and hemorrhage.2. Abnormal complete picture of blood was commonly seen in our study withdyshaematopoiesis. M3, M4, M5 were major FAB classification, withabnormalities in cytogenetics and molecular biology.3. In our study, the cases with M3 type of breast cancer t-AL were all CR afterinduction chemotherapy with retinoic acid and daunorubicin. However, thestandard Anthracyclines + Cytarabine, HA(Homoharringtonine + Cytarabine)regimen were not efficient for the non-M3 type patients, and relapse wascommon after remission leading to poor prognosis. Allogeneic hematopoieticstem cell transplantation is recommended as early as possible after completeremission. |
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