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Myelodysplastic syndrome after acute promyelocytic leukemia: the European APL group experience

Leukemia volume 17, pages 1600–1604 (2003)Cite this article

Abstract

With improved treatment of acute promyelocytic leukemia (APL) by all trans retinoic acid (ATRA) combined to anthracycline–aracytin chemotherapy (CT), a larger number of those patients may be at risk of late complications. Recently, the Rome group reported five cases of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML, non-APL) occurring during the course of 77 APL patients (6.5%) in complete remission (CR). From 1991 to 1998, we treated 677 newly diagnosed cases of APL, and 617 of them achieved CR with ATRA combined to CT (n=579) or CT alone (n=38); 246 of them received subsequent maintenance CT with 6 mercaptopurine and methotrexate. With a median follow-up of 51 months, 6 patients (0.97%) developed MDS, 13–74 months after the diagnosis of APL. In all six cases, t(15;17) and PML-RARalpha rearrangement were absent at the time of MDS diagnosis, and karyotype mainly showed complex cytogenetic abnormalities involving chromosomes 5 and/or 7, typical of MDS observed after treatment with alkylating agents, although none of the six patients had received such agents for the treatment of APL. Our findings suggest that MDS can indeed be a long-term complication in APL, although probably at lower incidence than that previously reported.

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Acknowledgements

This work was supported by the Ligue Nationale Centre le Cancer (Comilé du Nord). The Association de Accheriche Centre le Cancer and the Programme Hospitalion de Recherche Clinique.

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Authors and Affiliations

  1. Service des Maladies du Sang, CHU Lille, France

    I Lobe

  2. Service d'Hématologie, CHU Toulouse, France

    F Rigal-Huguet

  3. Département d'Hématologie et Oncologie Médicale, Hôpital Hôtel-Dieu, Paris, France

    A Vekhoff

  4. Service des Maladies du Sang, CHU Amiens, France

    B Desablens

  5. Service d'Hématologie Clinique, CHU Limoges, France

    D Bordessoule

  6. Département d'Hématologie, CHU Saint-Etienne, France

    C Mounier

  7. Service d'Hématologie, UCL Bruxelles, Belgium

    A Ferrant

  8. Hospital Clinico de Valencia, Espagne

    M Sanz

  9. Medical Institute (INSEL), Bern, Switzerland

    M Fey

  10. Laboratoire de Biologie Cellulaire Hématopoïétique, Hôpital Saint-Louis, Paris, France

    C Chomienne

  11. DBIM, Hôpital Saint-Louis, Paris, France

    S Chevret

  12. Institut d'Hématologie, Hôpital Saint-Louis, Paris, France

    L Degos

  13. Service d'hématologie clinique, Hôpital Avicenne, Bobigny, France

    P Fenaux

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for the European APL group

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Correspondence to P Fenaux.

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Lobe, I., Rigal-Huguet, F., Vekhoff, A. et al. Myelodysplastic syndrome after acute promyelocytic leukemia: the European APL group experience. Leukemia 17, 1600–1604 (2003). https://doi.org/10.1038/sj.leu.2403034

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