Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hematol. Feb 25, 2022; 9(1): 1-5
Published online Feb 25, 2022. doi: 10.5315/wjh.v9.i1.1
Central nervous system recurrence in a patient treated for acute promyelocytic leukemia, resulting in sideroblastic anemia: A case report
Haroon Nawaz, Ayesha Choudhry, William Joseph Morse
Haroon Nawaz, Department of Internal Medicine, Westside Regional Medical Center, Plantation, FL 33324, United States
Ayesha Choudhry, MBBS, Fatima Jinnah Medical University, Mozang Chungi, Lahore 54000, Punjab, Pakistan
William Joseph Morse, Clinical Medical Student, Ross University School of Medicine, Miramar, FL 33027, United States
Author contributions: Morse WJ was a major contributor in the writing of the manuscript; Nawaz H oversaw the patient with the attending physician and contributed to the editing of the paper; Choudhry A helped with the interpretation of the patient data; all authors approved the final manuscript.
Informed consent statement: Study participant provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: William Joseph Morse, Academic Research, Clinical Medical Student, Ross University School of Medicine, 2300 SW 145th Ave No. 200, Miramar, FL 33027, United States. wmorse001@gmail.com
Received: June 23, 2021
Peer-review started: June 23, 2021
First decision: July 31, 2021
Revised: August 1, 2021
Accepted: January 29, 2022
Article in press: January 29, 2022
Published online: February 25, 2022
Processing time: 244 Days and 18 Hours
Abstract
BACKGROUND

Previous cases that have been stated in this article have displayed that around 1% to 7% of patients that have been treated with chemotherapy for acute promyelocytic leukemia developed myelodysplastic syndrome or acute myeloid leukemia. One can see that’s why this case presentation of a 60-year-old man that had a good response to acute promyelocytic leukemia treatment, that later presented with a central nervous system recurrence of acute promyelocytic leukemia and acquired sideroblastic anemia (a form of myelodysplasia) from treatment is a unique case report.

CASE SUMMARY

The presence of central nervous system relapse in acute promyelocytic leukemia patients is very unlikely compared to recurring mainly in the bone marrow. It is also uncommon to be diagnosed with sideroblastic anemia (form of myelodysplastic syndrome) as a result from treatment for acute promyelocytic leukemia. This case report highlights the detection, treatment/maintenance with idarubicin, all-trans-retinoic-acid, arsenic trioxide, methotrexate, 6-mercaptopurine, and ommaya reservoir intrathecal methotrexate administration in a patient that had central nervous system relapse of acute promyelocytic leukemia and acquired sideroblastic anemia.

CONCLUSION

In essence, first time relapse concerning the central nervous system in treated acute promyelocytic leukemia patients who had a good response to therapy is very uncommon. The acquirement of a myelodysplastic syndrome such as ringed sideroblastic anemia is also rare regarding this patient population. Although such cases are infrequent, this case report represents a unique insight of the detection, treatment, and maintenance of a 60-year-old man diagnosed with acute promyelocytic leukemia, resulting in the acquirement of sideroblastic anemia and central nervous system relapse.

Keywords: Acute promyelocytic leukemia; Central nervous system relapse; Sideroblastic anemia; All-trans-retinoic acid; Myelodysplasia; Case report

Core Tip: Central nervous system recurrence and acquirement of sideroblastic anemia is a rare occurrence on their own and are even more unlikely to occur together in treated acute promyelocytic leukemia patients. We present a case presentation of a 60-year-old man that had a good response to acute promyelocytic leukemia treatment, that later presented with a central nervous system recurrence of acute promyelocytic leukemia and acquired sideroblastic anemia (a form of myelodysplasia) from treatment is a unique case report.