A Case of Therapy-Related Acute Monocytic Leukemia following Low-dose of Etoposide Treatment for Hemophagocytic Lymphohistiocytosis

Young Ik Seo; Rojin Park; Tae Youn Choi; Jeung Won Shin; Jong Ho Won; Hee-Sook Park; Nam-Soo Lee; Duck Cho

doi:10.3343/kjlm.2007.27.4.244

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Seo, Park, Choi, Shin, Won, Park, Lee, and Cho: A Case of Therapy-Related Acute Monocytic Leukemia following Low-dose of Etoposide Treatment for Hemophagocytic Lymphohistiocytosis

Original Article

Korean J Leg Med 2007;27(4):244-247.

Published online: 10 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.4.244

A Case of Therapy-Related Acute Monocytic Leukemia following Low-dose of Etoposide Treatment for Hemophagocytic Lymphohistiocytosis

Young Ik Seo, M.D.¹, Rojin Park, M.D.¹, Tae Youn Choi, M.D.¹, Jeung Won Shin, M.D.¹, Jong Ho Won, M.D.², Hee-Sook Park, M.D.², Nam-Soo Lee, M.D.², Duck Cho, M.D.³

¹Department of Laboratory Medicine, Soonchunhyang University Hospital, Seoul, Korea

²Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea

³Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea

Received 26 January 2007 Revised 25 May 2007 Accepted 25 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of therapy-related acute myeloid leukemia after low-dosed topoisomerase II inhibitor (etoposide) treatment for hemophagocytic lymphohistiocytosis (HLH). A 62-yr-old female patient had previously been treated with a HLH-94 protocol containing a low-dose of etoposide (total dose of 300 mg/m²). Thirty-one months later, the patient was admitted to the hematology department with general weakness and upper respiratory infection symptoms. Peripheral blood smear and bone marrow study revealed acute monocytic leukemia. There was no evidence of myelodysplastic syndrome, and a cytogenetic study showed no chromosomal abnormalities.

Keywords: Etoposide, Hemophagocytic lymphohistiocytosis, Therapy-related acute leukemia

References

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Fig. 1.

Initial bone marrow aspirate smear. Histiocytes were increased in number and counted up to 15% of all nucleated cells. Hemophagocytosis was predominantly observed (Wright-Giemsa stain, ×1,000).

Fig. 2.

Bone marrow aspirate smear 31 months following etoposide treatment. Promonocytes and monoblasts accounted for 89% of all nucleated cells (Wright-Giemsa stain, ×1,000).

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