Asunto(s)
Puntos de Rotura del Cromosoma , Cromosomas Humanos Par 15/genética , Cromosomas Humanos Par 17/genética , Leucemia Promielocítica Aguda/genética , Neoplasias Primarias Secundarias/genética , Proteínas de Fusión Oncogénica/genética , Translocación Genética/genética , Adulto , Anciano , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Cromosomas Humanos Par 15/ultraestructura , Cromosomas Humanos Par 17/ultraestructura , Femenino , Humanos , Leucemia Promielocítica Aguda/etiología , Masculino , Persona de Mediana Edad , Mitoxantrona/efectos adversos , Mitoxantrona/uso terapéutico , Esclerosis Múltiple/tratamiento farmacológico , Neoplasias/tratamiento farmacológico , Isoformas de Proteínas/genética , Inhibidores de Topoisomerasa II/efectos adversos , Inhibidores de Topoisomerasa II/uso terapéuticoRESUMEN
We report the clinical features and treatment outcome of 33 patients with multiple sclerosis who developed acute promyelocytic leukemia. Thirty patients were previously exposed to mitoxantrone. The median latency period between treatment initiation and acute promyelocytic leukemia diagnosis was 32 months. The PML-RARA bcr1 iso-form was identified in 87% of cases. Twenty-nine (90%) patients achieved hematologic remission after all-trans retinoic acid and chemotherapy (n = 31) or arsenic trioxide and all-trans retinoic acid. Consolidation included modified chemotherapy or arsenic trioxide. At a median follow up of 26 months, 23 patients are in complete remission, 4 relapsed and one developed secondary leukemia. The 5-year cumulative incidence of relapse and overall survival were 23% and 68%, respectively. Although treatment heterogeneity and suboptimal post-remission therapy must be taken into account, overall results and development of secondary leukemia in one patient suggest that effective and less toxic agents like arsenic trioxide warrants further investigation in this context.
