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Carcinomatosis lymphangitis and pleurisy after allo-SCT in two patients with secondary leukemia after breast cancer

Bone Marrow Transplantation volume 47, pages 155–156 (2012)Cite this article

AML has been described as a complication of breast cancer treatment with radiotherapy and chemotherapy.1, 2 The cumulative incidence at 5 years for developing secondary leukemia is 1.01% for patients receiving the more intense doxorubicin-CY regimens (two or four cycles of CY at 2400 mg/m2), compared with 0.21% for patients treated with standard regimens (four cycles of CY at 600 mg/m2).2 The usually recognized curative option for secondary leukemia includes chemotherapy followed by hematopoietic SCT (HSCT).3, 4 A significant proportion of women with leukemia after breast cancer treatment experience disease-free survival after HSCT similar to that of patients with de novo leukemia, and no patient with relapsed breast cancer is reported.4 We reported on two cases of women who achieved AML CR before HSCT, but associated with a rapid relapse of breast cancer.

In May 2005, a 39-year-old woman presented with right breast cancer: pT1pN0M0 RH− CERB2− SBR III infiltrating ductular carcinoma. She was treated with surgery (lumpectomy and axillary lymph node surgery), FEC 100 adjuvant chemotherapy (6 cycles: 5 fluoro-uracil 500 mg/m2, epirubicin 100 mg/m2 and CY 500 mg/m2) and local radiotherapy. In January 2008, she was referred to our unit for AML type 2 with abnormal karyotype (t(8;21)) and AML1-ETO rearrangement. Induction chemotherapy included idarubicin 8 mg/m2 and aracytine 200 mg/m2 (5+7). Reinduction chemotherapy on day 15 was necessary and included idarubicin 8 mg/m2 and aracytine 2000 mg/m2 (2+4). She was in CR after reinduction chemotherapy with an undetectable AML1/ETO transcript. Due to the poor prognosis of this AML, unrelated cord blood transplantation was performed in June 2008. The pretransplantation evaluation confirmed remission for breast cancer; left ventricular ejection fraction (EF) was assessed by biplanar cross-sectional echocardiography and was estimated at about 60%. Myeloablative conditioning consisted of fludarabine 25 mg/m2 (D-6, D-5 and D-4), CY 60 mg/kg (D-5 and D-4), and TBI (12 Gy, 6 fractions and 3 days). GVHD prophylaxis was provided with per os mycophenolate mofetil and i.v. CYA. On day 11, she presented with chest pain, tachycardia and pericardial effusion. Echocardiography revealed a dilated right ventricle with an EF of about 40%. On day 18, she presented with massive, both pericardial and pleural, effusion with anasarca and was transferred to the intensive care unit. Analysis of pleural fluid resulted in positive detection of carcinomatosis cells. Breast cancer tumor markers were positive (CA15-3=70 and CEA=7.4). Neutrophil engraftment was achieved at day 21. On day 25, she presented liver abnormalities and a depressed level of consciousness. She was intubated and ventilated. At this date, PCR of HHV6 was positive and treated with ganciclovir. One month later (day 34), moderate digestive GVHD occurred, requiring immunosuppression with methylprednisolone. On day 38, she presented fever and right pneumonia. On day 49, EF was of about 45%, with grade 2 tricuspid regurgitation and a non-dilated right ventricle. On day 56, she died of multi-organ failure.

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Authors and Affiliations

  1. Département d’Hématologie Clinique, Institut de Cancérologie de la Loire, St-Etienne, France

    E Chalayer, E Tavernier-Tardy & J Cornillon

  2. Département d’Oncologie médicale, Institut de Cancérologie de la Loire, St-Etienne, France

    G Clavreul

  3. Service de Thérapie Cellulaire et d'Hématologie Clinique Adulte, CHU Clermont Ferrand, Hôp. Estaing, Clermont-Ferrand, France

    J-O Bay

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  1. E Chalayer
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Correspondence to J Cornillon.

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Chalayer, E., Tavernier-Tardy, E., Clavreul, G. et al. Carcinomatosis lymphangitis and pleurisy after allo-SCT in two patients with secondary leukemia after breast cancer. Bone Marrow Transplant 47, 155–156 (2012). https://doi.org/10.1038/bmt.2011.30

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