Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4402-4407
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4402
Secondary acute promyelocytic leukemia following chemotherapy for gastric cancer: A case report
Ying-Cheng Zhang, Yu-Qi Zhou, Bing Yan, Jun Shi, Li-Juan Xiu, Yu-Wei Sun, Xuan Liu, Zhi-Feng Qin, Pin-Kang Wei, Yong-Jin Li
Ying-Cheng Zhang, Yu-Qi Zhou, Bing Yan, Jun Shi, Li-Juan Xiu, Yu-Wei Sun, Xuan Liu, Zhi-Feng Qin, Pin-Kang Wei, Yong-Jin Li, Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
Bing Yan, Department of Oncology, Hainan branch of PLA General Hospital, Sanya 572013, Hainan Province, China
Author contributions: Zhang YC, Zhou YQ and Yan B contributed equally to this work; Zhang YC, Zhou YQ, Yan B, Shi J, Sun YW, Qin ZF and Wei PK contributed to research design; Zhang YC, Yan B and Li YJ analyzed data; Zhou YQ, Xiu LJ and Liu X conducted paper revisions; and Zhang YC, Zhou YQ, Yan B and Li YJ wrote the paper.
Supported by National Natural Science Foundation of China, No. 81173403.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of the Changzheng Hospital, Second Military Medical University.
Informed consent: Informed written consent was obtained from the study participant.
Conflict-of-interest: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong-Jin Li, PhD, Department of Traditional Chinese Medicine, Changzheng Hospital of the Second Military Medical University, No. 415 Fengyang Road, Huangpu District, Shanghai 200003, China. yongjingli888@163.com
Telephone: +86-21-81885476 Fax: +86-21-63520020
Received: October 30, 2014
Peer-review started: October 31, 2014
First decision: November 14, 2014
Revised: November 29, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 14, 2015
Processing time: 166 Days and 20.2 Hours
Abstract

Therapy-related acute myeloid leukemia (t-AML) refers to a heterogeneous group of myeloid neoplasms that develop in patients following extensive exposure to either cytotoxic agents or radiation. The development of t-AML has been reported following treatment of cancers ranging from hematological malignancies to solid tumors; however, to our knowledge, t-AML has never been reported following treatment of gastric cancer. In this study, we report the development of t-acute promyelocytic leukemia in a cT4N1M0 gastric cancer patient after an approximate 44 mo latency period following treatment with 4 cycles of oxaliplatin (OXP) (85 mg/m2 on day 1) plus capecitabine (1250 mg/m2 orally twice daily on days 1-14) in combination with recombinant human granulocyte-colony stimulating factor treatment. Karyotype analysis of the patient revealed 46,XY,t(15;17)(q22;q21)[15]/46,idem,-9,+add(9)(p22)[2]/46,XY[3], which, according to previous studies, includes some “favorable” genetic abnormalities. The patient was then treated with all-trans retinoic acid (ATRA, 25 mg/m2/d) plus arsenic trioxide (ATO, 10 mg/d) and attained complete remission. Our case illuminated the role of certain cytotoxic agents in the induction of t-AML following gastric cancer treatment. We recommend instituting a mandatory additional evaluation for patients undergoing these therapies in the future.

Keywords: Gastric cancer; Acute promyelocytic leukemia; Oxaliplatin; Capecitabine; Chemotherapy

Core tip: In the current study, t-acute promyelocytic leukemia (t-APL) was likely induced by treatment with oxaliplatin, capecitabine and recombinant human granulocyte-colony stimulating factor. The gastric cancer patient, classified as clinical stage cT4N1M0, had a rare karyotype: 46,XY,t(15;17)(q22;q21)[15]/46,idem,-9,+add(9)(p22)[2]/46,XY[3]. This case demonstrates that certain cytotoxic agents can induce t-APL in gastric cancer. We recommend mandatory additional evaluation for patients undergoing this treatment regimen.