Treatment Options and Care for Patients Who Develop Therapy-Related AML - Episode 1

Case Presentation of Therapy-Related AML

Rami Komrokji, MD:This is a case of a gentleman who had received prior chemotherapy for lymphoma. It’s a classic case of therapy-related AML. The case describes a gentleman who is 67 years old, had treatment for lymphoma with CHOP chemotherapy 3 years ago, and has now developed leukocytosis. His workup revealed that he has acute myeloid leukemia, which is considered therapy-related AML most of the time.

Therapy-related AML or MDS is an entity recognized by the WHO classification as a separate type of leukemia or MDS. There are a couple of types that we see. We call one type 1, which we usually see 5 years after treatment. We see it in patients who are heavily treated, like with autologous stem cell transplant. The risk varies, but it could be up to 10% or 15% in patients with Hodgkin lymphoma who are treated before transplant. We typically see type 2 earlier on, within 3 to 5 years of the initial therapy, mostly related to chemotherapies like topoisomerase inhibitors, such as anthracyclines, and CHOP. Those typically present more in an AML phase than an MDS phase. We don’t exactly know why certain patients develop therapy-related AML or MDS. It seems that some of those patients may have already have had mutations at a very small or low level. With the chemotherapy, those clones will expand, get subsequent hits, and develop therapy-related AML.

Transcript edited for clarity.

Case: A 67-Year-Old Man with Therapy-Related AML

  • A 67-year-old man who had received CHOP for diffuse large B-cell lymphoma 3 years prior
  • PMH: hypertension controlled with amlodipine
  • Laboratory results:
    • WBC 15 x 109/L
    • Serum creatinine 1.5 mg/dL
    • Normal LFTs
    • LVEF 50%
  • Diagnosis: Acute Myeloid Leukemia
  • ECOG PS 1
  • The patient received liposomal cytarabine and daunorubicin
  • His course was complicated by febrile neutropenia
  • After induction, <5% marrow blasts, neutrophil count (>1400/&micro;L), platelets 60,000/&micro;L