CPX-351 and allogeneic stem cell transplant for a therapy-related acute myeloid leukemia that developed after treatment of acute promyelocytic leukemia: a case report and review of the literature

TL;DR

A patient developed therapy-related acute myeloid leukemia 15 years after being treated for acute promyelocytic leukemia and was successfully treated with CPX-351 and a stem cell transplant.

Contribution

This case report highlights the use of CPX-351 followed by allogeneic stem cell transplant in treating therapy-related AML after APL.

Findings

The patient achieved remission after three cycles of CPX-351 therapy.

An allogeneic stem cell transplant was performed following remission induction.

The case underscores the importance of long-term monitoring in APL survivors.

Abstract

Therapy-related myeloid neoplasms (t-MNs), which develop after cytotoxic, radiation, or immunosuppressive therapy for an unrelated disease, account for 7%–8% of acute myeloid leukemia (AML). Worse outcomes and consequently shortened survival are associated with t-MNs as compared with de novo AML. Therapy-related MNs are being reported with increasing frequency in successfully treated acute promyelocytic leukemia (APL), in particular, before the introduction of all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO). Considering the high curability of APL, t-MNs represent one of the prognosis-limiting factors in this setting of leukemia. We report our experience with a patient who developed t-AML 15 years after treatment for APL. Treatment included three cycles of chemotherapy with CPX-351 (Vyxeos, Jazz Pharmaceuticals) followed, as in remission, by an allogeneic hematopoietic stem cell transplant. A review of available literature was also included.

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