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Japanese Journal of Clinical Oncology Advance Access published online on July 10, 2008
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyn057
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© The Author (2008). Published by Oxford University Press. All rights reserved

Therapy-Related Acute Promyelocytic Leukemia Caused by Hormonal Therapy and Radiation in a Patient with Recurrent Breast Cancer

Makiko Ono1, Takashi Watanabe2, Chikako Shimizu1, Nobuhiro Hiramoto2, Yasushi Goto2, Kan Yonemori1, Tsutomu Kouno1, Masashi Ando1, Kenji Tamura1, Noriyuki Katsumata1 and Yasuhiro Fujiwara1

1 Breast and Medical Oncology Division
2 Hematology Division, National Cancer Center Hospital, Tokyo, Japan

For reprints and all correspondence: Chikako Shimizu, Breast and Medical Oncology Division, National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, Tokyo 104-0045, Japan. E-mail: cshimizu{at}ncc.go.jp

Received January 31, 2008; accepted June 10, 2008

We report a patient with therapy-related acute promyelocytic leukemia (APL) that may have been caused by regional radiation or hormonal therapy after surgery. A 36-year-old Japanese woman developed right breast cancer and underwent breast-conserving surgery and regional radiation to the right breast without adjuvant systemic therapy because she wished to preserve her fertility. Two years later, she developed multiple bone metastases of breast cancer and received hormonal therapy. During the second line hormonal therapy, she developed APL and received induction and consolidation chemotherapy with all-trans retinoic acid (ATRA) and a combination of anthracycline and cytarabine. After she achieved a complete remission (CR) of the APL, her bone metastases of breast cancer progressed. She received weekly paclitaxel treatments and her bone marrow function recovered. However, 9 months later, her APL relapsed; she achieved a second CR after undergoing ATRA therapy again. This patient is thought to be a rare case of secondary leukemia, since the leukemia might have been caused by hormonal therapy and regional radiation without chemotherapy.

Key Words: secondary leukemia • tamoxifen • all-trans retinoic acid • breast-conserving surgery • radiation


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