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

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

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.

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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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