-

Abstract

The occurrence of myelodysplastic syndrome or acute myeloid leukemia has been reported after treatment with cytotoxic alkylating agent-based chemotherapy for solid tumors. We report a 50-year-old woman presented with abdominal distension, vomiting, and fatique. The abdominal tomography showed bilaterally ovarian masses and ascite. Surgery was performed and histopathology of the ovarian mass revealed moderately differentiated papillary adenocarcinoma of ovarian. The patient was treated with chemotherapy combination including paclitaxel and carboplatin for six cycles. At 4 years after chemotherapy, recurrence of the primary disease developed. She received carboplatin and paclitaxel. Two years later, complete blood count showed leukocyte count 15.700 /mm3 (15% myeloblasts), hemoglobin 8.7 g/dL, and platelet count 88.000 /mm3. Bone marrow examination and flow cytometry analysis were consistent with acute myeloid leukemia. Standard induction chemotherapy with idarubicin and cytosine arabinoside was administered with failure to achieve complete remission. At the follow-up, the patient died due to prolonged febrile neutropenia. In conclusion, patients who were treated with high dose or long term alkylating agents should particularly follow-up for secondary tumors

Keywords

• Ovarian carcinoma, chemotherapy, alkylating agents, acute myeloid leukemia

Acute Myeloid Leukemia in a Patient with Ovarian Carcinoma

Öz

We report a 50-year-old woman presented with abdominal distension, vomiting, and fatique. The abdominal tomography showed bilaterally ovarian masses and ascite. Surgery was performed and histopathology of the ovarian mass revealed moderately differentiated papillary adenocarcinoma of ovarian. The patient was treated with chemotherapy combination including paclitaxel and carboplatin for six cycles. At 4 years after chemotherapy, recurrence of the primary disease developed. She received carboplatin and paclitaxel. Two years later, complete blood count showed leukocyte count 15700 /mm3 (15% myeloblasts), hemoglobin 8.7 g/dL, and platelet count 88.000 /mm3. Bone marrow examination and flow cytometry analysis were consistent with acute myeloid leukemia. Standard induction chemotherapy with idarubicin and cytosine arabinoside was administered with failure to achieve complete remission. At the follow-up, the patient died due to prolonged febrile neutropenia. In conclusion, patients who were treated with high dose or long term alkylating agents should particularly follow-up for secondary tumors.

Anahtar Kelimeler

• Over karsinomu, kemoterapi, alkilleyici ajanlar, akut myeloid lösemi

References

1. Agarwal R, Kaye SB. Ovarian cancer: strategies for overcoming resistance to chemotherapy. Nat Rev Cancer. 2003;3(7):502-16.
2. See HT, Thomas DA, Bueso-Ramos C, Kavanagh J. Secondary leukemia after treatment with paclitaxel and carboplatin in a patient with recurrent ovarian cancer. Int J Gynecol Cancer. 2006;16 Suppl 1:236-40
3. Shah MA, Schwartz GK. Cell cycle-mediated drug resistance: an emerging concept in cancer therapy. Clin Cancer Res. 2001;7(8):2168-81.
4. Judson PL, Watson JM, Gehrig PA, et al. Cisplatin inhibits paclitaxel-induced apoptosis in cisplatin- resistant ovarian cancer cell lines: possible explanation for failure of combination therapy. Cancer Res. 1999;59(10):2425-32.
5. Thirman MJ, Larson RA. Therapy-related myeloid leukemia. 1996;10(2):293-320. Clin North Am.
6. Leone G, Voso MT, Sica S, et al. Therapy related leukemias: susceptibility, prevention and treatment. Leuk Lymphoma. 200;41(3-4):255-76.
7. Travis LB, Holowaty EJ, Bergfeldt K, et al. Risk of leukemia after platinum-based chemotherapy for ovarian cancer. N Engl J Med. 1999;340(5):351-7.
8. Greene MH. Is cisplatin a human carcinogen? J Natl Cancer Inst. 1992;84(5):306-12.

9. Hijiya N, Ness KK, Ribeiro RC, Hudson MM. Acute leukemia as a secondary malignancy in children and adolescents: current findings and issues. Cancer. 2009;115(1):23-35.
10. Pedersen-Bjergaard J. Radiotherapy-and chemo- therapy-induced myelodysplasia and acute myeloid leukemia. A review. Leuk Res. 1992;16(1):61-5.