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      Acute myeloid leukemia secondary to acute B lymphoblastic leukemia treated with maintenance therapy in a child: A case report

      case-report

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          Abstract

          Background

          Acute lymphoblastic leukemia (ALL) has the highest incidence among childhood hematologic cancers. Exposure to certain cytotoxic therapies for ALL is correlated with a higher risk of secondary malignancies.

          Case

          We report a rare case of a 6‐year‐old girl being diagnosed with secondary acute myeloid leukemia (AML) during her maintenance phase of treatment for ALL with TEL‐AML1 fusion gene, approximately 17 months after the primary diagnosis.

          Conclusion

          This case indicates that we should recognize the increased risk of secondary AML for pediatric ALL patients with TEL‐AML1 fusion gene if multiple alkylating drugs and inhibitors for topoisomerase II are included in induction chemotherapy.

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          Most cited references24

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          Pediatric acute lymphoblastic leukemia

          Hiroto Inaba, Charles Mullighan (2020)
          The last decade has witnessed great advances in our understanding of the genetic and biological basis of childhood acute lymphoblastic leukemia (ALL), the development of experimental models to probe mechanisms and evaluate new therapies, and the development of more efficacious treatment stratification. Genomic analyses have revolutionized our understanding of the molecular taxonomy of ALL, and these advances have led the push to implement genome and transcriptome characterization in the clinical management of ALL to facilitate more accurate risk-stratification and, in some cases, targeted therapy. Although mutation- or pathway-directed targeted therapy (e.g., using tyrosine kinase inhibitors to treat Philadelphia chromosome [Ph]-positive and Phlike B-cell-ALL) is currently available for only a minority of children with ALL, many of the newly identified molecular alterations have led to the exploration of approaches targeting deregulated cell pathways. The efficacy of cellular or humoral immunotherapy has been demonstrated with the success of chimeric antigen receptor T-cell therapy and the bispecific engager blinatumomab in treating advanced disease. This review describes key advances in our understanding of the biology of ALL and optimal approaches to risk-stratification and therapy, and it suggests key areas for basic and clinical research.
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            Pediatric AML: From Biology to Clinical Management

            Jasmijn de Rooij, C. Zwaan, Marry van den Heuvel-Eibrink (2015)
            Pediatric acute myeloid leukemia (AML) represents 15%–20% of all pediatric acute leukemias. Survival rates have increased over the past few decades to ~70%, due to improved supportive care, optimized risk stratification and intensified chemotherapy. In most children, AML presents as a de novo entity, but in a minority, it is a secondary malignancy. The diagnostic classification of pediatric AML includes a combination of morphology, cytochemistry, immunophenotyping and molecular genetics. Outcome is mainly dependent on the initial response to treatment and molecular and cytogenetic aberrations. Treatment consists of a combination of intensive anthracycline- and cytarabine-containing chemotherapy and stem cell transplantation in selected genetic high-risk cases or slow responders. In general, ~30% of all pediatric AML patients will suffer from relapse, whereas 5%–10% of the patients will die due to disease complications or the side-effects of the treatment. Targeted therapy may enhance anti-leukemic efficacy and minimize treatment-related morbidity and mortality, but requires detailed knowledge of the genetic abnormalities and aberrant pathways involved in leukemogenesis. These efforts towards future personalized therapy in a rare disease, such as pediatric AML, require intensive international collaboration in order to enhance the survival rates of pediatric AML, while aiming to reduce long-term toxicity.
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              Randomized trial comparing liposomal daunorubicin with idarubicin as induction for pediatric acute myeloid leukemia: results from Study AML-BFM 2004.

              Ursula Creutzig, Martin Zimmermann, Jean-Pierre Bourquin … (2013)
              Outcomes of patients with acute myeloid leukemia (AML) improve significantly by intensification of induction. To further intensify anthracycline dosage without increasing cardiotoxicity, we compared potentially less cardiotoxic liposomal daunorubicin (L-DNR) to idarubicin at a higher-than-equivalent dose (80 vs 12 mg/m(2) per day for 3 days) during induction. In the multicenter therapy-optimization trial AML-BFM 2004, 521 of 611 pediatric patients (85%) were randomly assigned to L-DNR or idarubicin induction. Five-year results in both treatment arms were similar (overall survival 76% ± 3% [L-DNR] vs 75% ± 3% [idarubicin], Plogrank = .65; event-free survival [EFS] 59% ± 3% vs 53% ± 3%, Plogrank = .25; cumulative incidence of relapse 29% ± 3% vs 31% ± 3%, P(Gray) = .75), as were EFS results for standard (72% ± 5% vs 68% ± 5%, Plogrank = .47) and high-risk (51% ± 4% vs 46% ± 4%, Plogrank = .45) patients. L-DNR resulted in significantly better probability of EFS in patients with t(8;21). Overall, treatment-related mortality was lower with L-DNR than idarubicin (2/257 vs 10/264 patients, P = .04). Grade 3/4 cardiotoxicity was rare after induction (4 L-DNR vs 5 idarubicin). Only 1 L-DNR and 3 idarubicin patients presented with subclinical or mild cardiomyopathy during follow-up. In conclusion, at the given dose, L-DNR has overall antileukemic activity comparable to idarubicin, promises to be more active in subgroups, and causes less treatment-related mortality. This trial was registered at www.clinicaltrials.gov as #NCT00111345.
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                Author and article information

                Contributors
                Yalin Liu: xykcls@163.com
                Journal
                Journal ID (nlm-ta): Cancer Rep (Hoboken)
                Journal ID (iso-abbrev): Cancer Rep (Hoboken)
                Journal ID (doi): 10.1002/(ISSN)2573-8348
                Journal ID (publisher-id): CNR2
                Title: Cancer Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2573-8348
                Publication date (Electronic): 26 September 2022
                Publication date Collection: November 2022
                Volume: 5
                Issue: 11 ( doiID: 10.1002/cnr2.v5.11 )
                Electronic Location Identifier: e1717
                Affiliations
                [ 1 ] Department of Hematology The First Affiliated Hospital of Xi'an Jiaotong University Xi'an People's Republic of China
                [ 2 ] Department of Pediatric The First Affiliated Hospital of Xi'an Jiaotong University Xi'an People's Republic of China
                Author notes
                [*] [* ] Correspondence

                Yalin Liu, Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, No.277 West of Yanta Road, Xi'an 710061, People's Republic of China.

                Email: xykcls@ 123456163.com

                Author information
                https://orcid.org/0000-0002-2472-4076
                Article
                Publisher ID: CNR21717
                DOI: 10.1002/cnr2.1717
                PMC ID: 9675377
                PubMed ID: 36164709
                SO-VID: 3e954560-389c-46ea-96ba-3d4008df5b18
                Copyright © © 2022 The Authors. Cancer Reports published by Wiley Periodicals LLC.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date revision received : 06 August 2022
                Date received : 22 June 2022
                Date accepted : 07 September 2022
                Page count
                Figures: 3, Tables: 0, Pages: 5, Words: 2769
                Funding
                Funded by: The Key Research and Development Program of Shaanxi Province
                Award ID: 2020SF‐174
                Award ID: 2020SF‐176
                Award ID: 2021SF‐302
                Award ID: 2022SF‐13
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                cover-date November 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.1 mode:remove_FC converted:19.11.2022

                Keywords: acute lymphoblastic leukemia,acute myeloid leukemia,secondary malignancy
                Data availability:
                Keywords: acute lymphoblastic leukemia, acute myeloid leukemia, secondary malignancy

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