Translocation (8;16) in a patient with acute myelomonocytic leukemia, occurring after treatment with fludarabine for a low-grade non-Hodgkin's lymphoma

We describe a 65-year old woman who developed a t(8;16)(p11;p13) positive a cute myeloid leukemia (AML)-M4 without prior myelodysplasia 36 months after a low-grade non-Hodgkin's lymphoma treated with alkylating agents (chloram bucil and cyclophosphamide) and fludarabine, a purine analog with a signifi cant activity in lymphoproliferative disorders. The t(8;16)(p11;p13) is pre sent in 0.4% of AML of M4-M5 cytotype. In the present case it was identifie d by conventional cytogenetics; involvement of the MOZ and CBP genes was de monstrated by fluorescence in situ hybridization, but not by reverse transc ription polymerase chain reaction. The patient died of sepsis after the fir st course of induction chemotherapy. This is the first t(8;16) AML-M4 arisi ng after fludarabine treatment of which the leukemogenic role in our case i s very difficult to ascertain. Most t(8;16) therapy-related-AML cases had r eceived anthracyclines with or without cyclophosphamide; none was ever admi nistered chlorambucil. Our patient was never given anthracyclines and the c umulative doses of chlorambucil and cyclophosphamide employed were low. (C) 2000, Ferrata Storti Foundation.