FISH shows 11q23 (MLL) gene rearrangement.
Diagnosis: Therapy-related acute myeloid leukemia
Therapy-related acute myeloid leukaemia (t-AML), myelodysplastic syndrome (t-MDS) and myelodysplastic/myeloproliferative neoplasms (t-MDS/MPN)
Late complications of cytotoxic chemotherapy and/or radiation therapy administered for a prior neoplastic or non-neoplastic disorder.
Acount for 10−20% of all cases of AML, MDS and MDS/MPN
Two subsets of t-AML/t-MDS and t-AML/ t-MDS/MPN are generally recognized.
Alkylating agents and/or ionizing radiation
Most commonly 5−10 years after exposure
Majority: t-MDS and evidence of BM failure with one or multiple cytopenias; minority: t-MDS/MPN or with overt t-AML.
Commonly associated with unbalanced loss of genetic material, often involving chromosomes
5 and/or 7.
Dysgranulopoiesis, dyserythropoiesis, dysmegakaryopoiesis
Alkylating agents
Melphalan, cyclophosphamide, nitrogen mustard, chlorambucil, busulfan, carboplatin, cisplatin,dacarbazine, procarbazine, carmustine, mitomycin C, thiotepa, lomustine, etc.
Ionizing radiation therapy
Large fields including active bone marrow
DNA topoisomerase II (topoisomerase II inhibitors) (20-30%)
Latency period 1−5 years
Most no myelodysplastic phase but present initially with overt acute leukaemia
Associated with a balanced chromosomal translocation
Frequently involve 11q23 (MLL) or 21q22 (RUNX1), and have morphology that resembles de novo acute leukaemia associated with these chromosomal abnormalities
Many: monoblastic leukaemia or myelomonocytic leukaemia
Topoisomerase II inhibitors
Etoposide, teniposide, doxorubicin, daunorubicin, mitoxantrone, amsacrine, actinomycin
Topoisomerase II inhibitors may also be associated with therapy-related lymphoblastic leukaemia
In practice many patients have received polychemotherapy that includes both classes of drugs and the boundary between the two categories is not always sharp.
Diagnosis: Therapy-related acute myeloid leukemia
Therapy-related acute myeloid leukaemia (t-AML), myelodysplastic syndrome (t-MDS) and myelodysplastic/myeloproliferative neoplasms (t-MDS/MPN)
Late complications of cytotoxic chemotherapy and/or radiation therapy administered for a prior neoplastic or non-neoplastic disorder.
Acount for 10−20% of all cases of AML, MDS and MDS/MPN
Two subsets of t-AML/t-MDS and t-AML/ t-MDS/MPN are generally recognized.
Alkylating agents and/or ionizing radiation
Most commonly 5−10 years after exposure
Majority: t-MDS and evidence of BM failure with one or multiple cytopenias; minority: t-MDS/MPN or with overt t-AML.
Commonly associated with unbalanced loss of genetic material, often involving chromosomes
5 and/or 7.
Dysgranulopoiesis, dyserythropoiesis, dysmegakaryopoiesis
Alkylating agents
Melphalan, cyclophosphamide, nitrogen mustard, chlorambucil, busulfan, carboplatin, cisplatin,dacarbazine, procarbazine, carmustine, mitomycin C, thiotepa, lomustine, etc.
Ionizing radiation therapy
Large fields including active bone marrow
DNA topoisomerase II (topoisomerase II inhibitors) (20-30%)
Latency period 1−5 years
Most no myelodysplastic phase but present initially with overt acute leukaemia
Associated with a balanced chromosomal translocation
Frequently involve 11q23 (MLL) or 21q22 (RUNX1), and have morphology that resembles de novo acute leukaemia associated with these chromosomal abnormalities
Many: monoblastic leukaemia or myelomonocytic leukaemia
Topoisomerase II inhibitors
Etoposide, teniposide, doxorubicin, daunorubicin, mitoxantrone, amsacrine, actinomycin
Topoisomerase II inhibitors may also be associated with therapy-related lymphoblastic leukaemia
In practice many patients have received polychemotherapy that includes both classes of drugs and the boundary between the two categories is not always sharp.