Four Cases of Hematologic Malignancy Following Radioactive Iodine Therapy for Thyroid Cancer

Mijeong Im; Jin Kyung Lee; Young Joon Hong; Seok Il Hong; Hye Jin Kang; Im Il Na; Baek-Yeol Ryoo; Gi Jeong Cheon; Ha Na Lee; Yoon Hwan Chang

doi:10.3343/kjlm.2008.28.6.425

Journal List > Korean J Lab Med > v.28(6) > 1011502

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Im, Lee, Hong, Hong, Kang, Na, Ryoo, Cheon, Lee, and Chang: Four Cases of Hematologic Malignancy Following Radioactive Iodine Therapy for Thyroid Cancer

Original Article

Korean J Leg Med 2008;28(6):425-429.

Published online: 14 February 2008

DOI: https://doi.org/10.3343/kjlm.2008.28.6.425

Four Cases of Hematologic Malignancy Following Radioactive Iodine Therapy for Thyroid Cancer

Mijeong Im, M.D.¹, Jin Kyung Lee, M.D.^1,⁴, Young Joon Hong, M.D.^1,⁴, Seok Il Hong, M.D.^1,⁴, Hye Jin Kang, M.D.², Im Il Na, M.D.², Baek-Yeol Ryoo, M.D.², Gi Jeong Cheon, M.D.³, Ha Na Lee, M.S.⁴, Yoon Hwan Chang, M.D.^1,^4,

¹Department of Laboratory Medicine, Korea Cancer Center Hospital, Seoul, Korea

²Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea

³Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Korea

⁴University of Science and Technology, Daejeon, Korea

Corresponding author: Yoon Hwan Chang, M.D. Department of Laboratory Medicine, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul 139-706, Korea Tel: +82-2-970-1283, Fax: +82-2-973-7143 E-mail: cyhlabo@kcch.re.kr

Received 9 June 200816 July 2008 Accepted 14 October 2008

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

Ionizing radiation including I¹³¹ might produce chromosomal translocation, causing hematologic malignancy. The incidence of leukemia following radioactive iodine treatment for thyroid cancer has been reported to be approximately 0.1 to 2.0% in Western countries, whereas fewer cases have been reported in Korea. We hereby report four cases of secondary hematologic malignancy, who received iodine therapy for thyroid cancer after thyroidectomy: two cases of acute lymphoblastic leukemia with t(9;22)(q34;q11.2), a case of MDS with 5q deletion, and a case of MDS with normal karyotype. Three cases of hematologic malignancy have developed after cumulative dosage of less than 800 mCi. The treatment intervals in two cases were less than 12 months, and the other two cases had I¹³¹ therapy only once. Assessment of causality using the Naranjo probability scale for adverse drug reactions showed that a ‘possible’ relationship existed between the use of I¹³¹ and secondary hematologic malignancy in all of the four cases in this report.

Keywords: Thyroid cancer, Radioisotope therapy

REFERENCES

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Table 1.

Four cases of secondary hematologic malignancy following treatment of I¹³¹ for thyroid cancer

No. Case	1	2	3	4
Histology	Follicular carcinoma	Papillary carcinoma July, 1990	Follicular carcinoma March, 1999	Papillary carcinoma February, 2004
	First surgery: August, 1983
	Second surgery: June, 1993
I¹³¹ (mCi)	400	176	1,400	180
Secondary hematologic malignancy	Precursor B-ALL, February, 2000	Precursor B-ALL, October, 2002	MDS (RCMD) April, 2005	MDS (RAEB-2) January, 2007
Age (yr) and sex at diagnosis of secondary hematologic malignancy	49/F	43/F	52/F	54/F
Karyotype	43-45,XX,del(9)(q21), t(9;22)(q34;q11.2), i(17)(q10),-20[cp7]	46,XX,t(9;22)(q34;q11.2) [2]/46,XX[50]	del(5q) (68.5%) [FISH]	46,XX[20]
Latency (months)	80 (since the treatment of recurred cancer)	146	73	35
Current status	Follow up loss after 1 cycle of induction therapy	Recurrence	Died of pneumonia 2 weeks after conservative therapy	Alive (evolved to AML)

Abbreviations: ALL, acute lymphoblastic leukemia; RCMD, refractory cytopenia with multilineage dysplasia; RAEB, refractory anemia with excess blasts; AML, acute myeloid leukemia.

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