Acute promyelocytic leukemia after treatment for non-Hodgkin's lymphoma with drugs targeting topoisomerase II

We report a patient who developed acute promyelocytic leukemia (APL) concom itantly with a second relapse of non-Hodgkin's lymphoma (NHL), intermediate grade, WF type E. At diagnosis and at first NHL relapse, the patient had r eceived the same chemotherapy regimen, which included drugs targeting DNA t opoisomerase II, i.e., etoposide (total dose 5,760 mg) and idarubicin (tota l dose 180 mg). Thirty-eight months after initial treatment, the patient sh owed pancytopenia associated with lymphoma recurrence. Bane marrow examinat ion revealed the presence of atypical promyelocytes with Auer rods; cytogen etics showed t(15;17), and molecular analysis detected promyelocytic leukem ia-retinoic acid receptor alpha rearrangement. APL reached complete remissi on after all trans retinoic acid therapy, whereas NHL did not respond to fu rther chemotherapy. In the literature, five other patients developed APL af ter treatment for lymphoma, from a total of 59 patients developing sAPL aft er treatment for any type of neoplasia. (C) 1999 Wiley-Liss, Inc.