CML-206 Secondary Chronic Myeloid Leukemia Following Successful Treatment of Metastatic Colon Cancer: A Case Report

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 23; p. S333
• Main Authors: Denewer, May, Abouzid, Amr, Denewer, Dina A, Shabaan, Yasmine
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-09-2023
• Subjects: CML; colon cancer; FOLFOX; CML; FOLFOX; colon cancer; case
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/S2152-2650(23)01125-4

Hematological malignancies developing after previous chemo and/or radiotherapy for solid tumors are called therapy-related myeloid neoplasms. Secondary malignancies after chronic myeloid leukemia (CML) was reported in 3% of cases. While the definition of secondary CML is not well defined, reports about treatment-related CML are increasing in patients treated for solid tumors.
We report a case of CML following treatment for colon cancer. Chemotherapy used for treatment of colon cancer could be carcinogenic.
An observational study from March 2011 until June 2023.
Hematology and transplant unit, Oncology Center, Mansoura University, Egypt.
In 2011, a 49-year-old man presented with abdominal pain and constipation. Colonoscopy revealed a polypoidal mass and the biopsy showed an adenomatous polyp suspicious for malignancy. Five days later, a transverse loop colostomy was done because the patient had an intestinal obstruction. The pathological report was consistent with adenocarcinoma. Abdominal CT showed liver metastasis and locally advanced colon cancer.
The patient started neoadjuvant chemotherapy with FOLFOX-4 for 12 cycles until the liver metastasis completely disappeared. Then the patient underwent an extended left hemicolectomy with primary anastomosis. Postoperative pathology revealed a G II adenocarcinoma T2 N0. The patient continued follow-up and was completely cancerfree.
About 11 years later, the patient presented with left hypochondriac region discomfort, leukocytosis 130 k/μl. Peripheral blood smear showed granulocytosis with a shift to the left. Bone marrow aspiration showed a case of CML (chronic phase). Sokal score was intermediate risk. Patient started hydroxyurea to control hyperleukocytosis. A complete revaluation for colon cancer found none. Quantitative RT-PCR detected 90.78% (BCR/ABL fusion gene mRNA). Two weeks later, the patient started nilotinib 300 mg BID.
Treatment-related CML cannot be differentiated from de novo CML by cytogenetics, unlike therapy-related AML. Fluorouracil and oxaliplatin can cause translocation in bone marrow stem cells. So, it is suggested that a complete blood count be checked after treatment in the follow-up of solid tumors.