AML-624 Synchronous Diagnosis of Acute Promyelocytic Leukemia (APL) and Relapsed Breast Cancer (RBC)

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 24; pp. S326 - S327
• Main Authors: Rasmaoui, Asmae, Lamchahab, Mouna, Benazzouz, Hamza, Oukkache, Bouchra, Hda, Nazha, Benmoussa, Amine, Qachouh, Meryem, Rachid, Mohamed, Cherkaoui, Siham, Khoubila, Nissrine, Madani, Abdellah
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2024
• Subjects: acute promyelocytic leukemia; AML; complete remission; relapsed breast cancer; synchronous cancers; AML; acute promyelocytic leukemia; synchronous cancers; complete remission; case; relapsed breast cancer
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01225-4

Data on synchronous diagnosis of acute myeloid leukemia (AML) and breast cancer (BC) are lacking. This case report highlights the concurrent diagnosis of acute promyelocytic leukemia (APL) and relapsed BC (RBC) in a single patient.
To present the management of a patient with simultaneous APL and RBC, emphasizing the complexities and multidisciplinary approach required.
Case report.
Hematology department of a tertiary care hospital.
A 45-year-old woman previously diagnosed with localized BC, treated in 2019 and who later developed an APL concomitant to RBC.
Treatment response, and remission status of both APL and RBC.
Initial BC diagnosis (2019): Localized infiltrating ductal carcinoma (pT2N1M0) with hormone receptor expression (ER 95%, PR 60%) and a negative HercepTest, treated with surgery, chemotherapy (docetaxel and anthracyclines), radiotherapy, and tamoxifen. RBC and APL diagnosis (2023): RBC nodule observed in March 2023. Gingival bleeding and ecchymoses led to a diagnosis of APL in April 2023. CBC showed cytopenias (hemoglobin level of 7.8 g/dL, a platelet count of 25 × 109/L, leukocyte count of 7600/mm3 and neutrophil count of 230/mm3) with blastosis (92%). Bone marrow aspiration (BMA) and immunophenotyping confirmed APL. Blasts were positive for MPO, CD33, CD13, and CD64. HLADR, CD34 and lymphoid markers were negative. Medullar karyotype revealed a t(15;17) (q24;q21) translocation. APL Treatment and Remission: The cumulative dose of anthracyclines was 180 mg/m2. Treated with PETHEMA protocols for intermediate risk. Complete medullary remission achieved by May 2023, confirmed by BMA and cytogenetic studies. First consolidation cure was performed on 05/30/2023. The Multidisciplinary team (MDT) decision was to proceed directly to maintenance therapy and refer the patient back to the oncology department. Minimal residual disease (MRD) assessment in March 2024 confirmed sustained molecular remission of APL. BC management (2023-2024): RBC confirmed via biopsy. The staging did not reveal any metastases. MDT decided on mastectomy (November 2023) and continued tamoxifen as adjuvant therapy. Patient is scheduled for surgical castration.
The simultaneous management of APL and RBC necessitates a multidisciplinary approach. Despite the complexity and cardiotoxicity from prior anthracycline treatment, the patient achieved complete remission.