Secondary Acute Myeloid Leukemia Following Chemotherapy for Angioimmunoblastic T-Cell Lymphoma

Angioimmunoblastic T-cell lymphoma (AITL) is a rare and aggressive form of peripheral T-cell lymphoma, accounting for 1 - 2% of non-Hodgkin lymphomas. Diagnosis is challenging, and there is no established standard first-line treatment. This case report highlights a rare progression from AITL to therapy-related acute myeloid leukemia (AML-pCT) following cytotoxic chemotherapy.

A 61-year-old male presented with fever and a painless right submandibular mass. Initial biopsy and immunohistochemistry confirmed AITL. The patient underwent multiple cycles of chemotherapy, including cyclophosphamide, dexamethasone, bortezomib, and etoposide. Post-treatment, the patient developed severe pancytopenia and was later diagnosed with AML-pCT based on bone marrow examination, flow cytometry, and molecular genetic testing.

The patient's initial treatment for AITL included B-CVP and bortezomib-based regimens. Despite initial response, the patient developed AML-pCT, characterized by elevated white blood cells, peripheral blasts, and bone marrow findings of 49.6% blasts. Molecular analysis revealed mutations in FLT3, DNMT3A, TET2, and NPM1. The progression to AML-pCT was attributed to prior cytotoxic therapy, particularly alkylating agents and topoisomerase II inhibitors.

This case underscores the rare but significant risk of AML-pCT following cytotoxic chemotherapy for AITL. The presence of specific genetic mutations further supports the diagnosis of therapy-related AML. Clin-icians should be vigilant for such complications in patients receiving intensive chemotherapy, particularly those with underlying hematologic malignancies. Early recognition and tailored management are crucial for improving outcomes in these complex cases.