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A case of acute promyelocytic leukaemia following mitoxantrone treatment of multiple sclerosis

Leukemia volume 17, pages 985–986 (2003)Cite this article

TO THE EDITOR

Multiple sclerosis (MS) is an autoimmune disease characterised by a relapsing–remitting course or by a gradual decline of neurologic function caused by immune activity directed against central nervous system antigens. At present, an immunosuppressive or immunomodulatory therapy seems to be most promising.1 Indeed, although MS has been considered for long time as an unmanageable disease, some drugs have recently shown activity in controlled studies and have been approved for therapeutic use. Among them mitoxantrone, an anthracenedione synthetic agent, has been licensed for use in secondary progressive and progressive relapsing MS, and there is consensus on the earlier use of active drugs before irreversible clinical disability has developed.2 The mechanism of action of mitoxantrone in MS is poorly understood. Its common side effects include cardiac and hematological toxicity. A potentially fatal side effect is the development of acute myeloblastic leukemia/myelodysplastic syndrome (AML/MDS). In fact, like other topoisomerase-II (topo-II) inhibitors, mitoxantrone can induce DNA cleavage and chromosome aberrations, including sister chromatids exchanges, thus favouring the development of neoplastic clones.3 The development of secondary leukemia in MS patients treated with chlorambucil, an alkylating agent with well-known leukemogenic potential, has been documented in the past.4 Recently, two cases5,6 of acute leukemia following mitoxantrone therapy for MS have been reported. Herein, we describe a patient treated with mitoxantrone for MS who developed acute promyelocytic leukemia (APL).

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Acknowledgements

We thank Professor Francesco Lo Coco for reviewing the manuscript.

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  1. Sezione di Ematologia, Spedali Civili, Brescia, Italy

    C Cattaneo, C Almici, E Borlenghi, M Motta & G Rossi

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  1. C Cattaneo
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Cattaneo, C., Almici, C., Borlenghi, E. et al. A case of acute promyelocytic leukaemia following mitoxantrone treatment of multiple sclerosis. Leukemia 17, 985–986 (2003). https://doi.org/10.1038/sj.leu.2402887

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