Acute Promyelocytic Leukemia with double minute chromosomes: a rare case with high relapse risk
Yohei Sasaki1, Shotaro Shimada1, Natsuki Kawamata1
1Division of Hematology, Department of Medicine, Showa Medical University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo 142-8666, Japan.
Abstract:
Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML); it has a high response rate and long-term survival with differentiation therapy and chemotherapy. However, only one previous case of APL with double minute chromosomes (DMs, a poor prognostic factor for AML) has been reported. We report the case of a patient with APL and DMs. A 44-year-old woman was treated with all-trans retinoic acid (ATRA) and chemotherapy and achieved molecular complete remission (mCR). However, the condition relapsed after 15 months. She was treated with arsenic trioxide and autologous transplantation and experienced mCR. Her peripheral blood was positive for minimal residual disease (MRD) 2 months after autologous transplantation. She became MRD-negative with ATRA and has maintained the negative status for 15 months. This is the first report to suggest that patients with APL and DMs may be a high-risk group for relapse and benefit from maintaining with ATRA.
Insights
Acute promyelocytic leukemia (APL) with double minute chromosomes (DMs) may indicate a high relapse risk. Maintenance therapy with all-trans retinoic acid (ATRA) may benefit these patients, as seen in this case study.
Area of Science:
- Hematology
- Oncology
- Genetics
Background:
- Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML).
- Double minute chromosomes (DMs) are a rare finding in APL and considered a poor prognostic factor in AML.
- Limited data exists on the clinical course and management of APL with DMs.
