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Acute promyelocytic leukemia after mitoxantrone therapy for multiple sclerosis
Bhuvaneswari Ramkumar1, Manpreet K Chadha, Maurice Barcos
1Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA.
Cancer Genetics and Cytogenetics
|April 15, 2008
Summary
Mitoxantrone, used for multiple sclerosis (MS), may increase the risk of developing acute promyelocytic leukemia (APL). This report details two new cases, suggesting a specific association between mitoxantrone therapy and t-APL.
Area of Science:
- Oncology
- Hematology
- Neurology
Background:
- Mitoxantrone is a DNA-topoisomerase 2 inhibitor utilized in treating relapsing-remitting and progressive multiple sclerosis (MS).
- Therapy-related acute myeloid leukemia (t-AML), particularly with 11q23 abnormalities, is a known risk associated with topoisomerase 2 inhibitors.
Observation:
- Two patients treated with mitoxantrone for MS subsequently developed acute promyelocytic leukemia (APL).
- These cases represent the eighth and ninth documented instances of APL following mitoxantrone treatment for MS.
Findings:
- The occurrence of therapy-related APL (t-APL) is less common than t-AML.
- The cumulative reports suggest a potential specific association between mitoxantrone therapy and the development of t-APL in MS patients.
Implications:
- This association warrants further investigation into the specific mechanisms linking mitoxantrone to t-APL.
- Clinicians should be aware of this potential risk when prescribing mitoxantrone for multiple sclerosis.
- Enhanced surveillance for hematologic malignancies may be considered in MS patients undergoing mitoxantrone treatment.
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