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Acute Myeloid Leukemia Acquiring Promyelocytic Leukemia-Retinoic Acid Receptor Alpha at Relapse

Varsha Gupta1, Mohammed Shariff1, Ravneet Bajwa1

  • 1Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA.

World Journal of Oncology
|July 18, 2019
PubMed

Insights

This study reports a rare case of acute promyelocytic leukemia (APL) relapsing after AML chemotherapy. The patient achieved remission with ATRA and arsenic trioxide therapy after secondary PML-RARA acquisition.

Area of Science:

  • Hematology
  • Oncology
  • Molecular Biology

Background:

  • Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) with a high cure rate.
  • Standard chemotherapy for AML was administered to a patient with a rare presentation of the disease.
  • The genetic hallmark of APL, the t(15;17) translocation, was absent at initial diagnosis.

Observation:

  • A patient initially diagnosed with AML relapsed after one year of chemotherapy.
  • The relapsed disease exhibited the characteristic t(15;17) translocation, forming the PML-RARA fusion gene.
  • This genetic abnormality was not detected at the time of the initial AML diagnosis.

Findings:

  • The patient achieved complete remission after treatment with all-trans retinoic acid (ATRA) and arsenic trioxide.
  • The secondary acquisition of the PML-RARA fusion gene at relapse is a key finding.
  • This suggests a potential mechanism for disease evolution in certain AML cases.

Implications:

  • This case highlights the importance of reassessing genetic profiles at relapse in AML.
  • Understanding the secondary acquisition of PML-RARA may lead to novel therapeutic strategies for APL.
  • Further research into the mechanisms of secondary genetic alterations in leukemia is warranted.
Keywords:
Acute myeloid leukemiaAcute promyelocytic leukemiaAll-trans retinoic acid

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