AML-139 Early Onset of Therapy-Related Acute Myeloid Leukemia in a Patient Treated for a Hodgkin Lymphoma

Therapy-related acute myeloid leukemia (t-AML) is a known complication of certain types of therapies, such as cytotoxic, radiation, or immunosuppressants. At present, t-AML incidence is relatively low. However, this is expected to change in the near and medium future due to improved overall survival rates. t-AML can occur a few months to several years after the initial therapy, depending on the type and dosage of therapy and patient-specific variation. The prognosis is generally poor, with patients presenting complex karyotype and significant structural abnormalities. As such, the optimal treatment remains a challenge.We report the case of a patient treated for a Hodgkin lymphoma stage IIB in December 2019, who underwent 8 cycles of ABVD and radiotherapy 30 Gy with a negative PET scan in August 2020, diagnosed with acute monoblastic leukemia (M5a - FAB) in January 2021.A 53-year-old male, smoker, presented with fatigue and oliguria for the past month. Laboratory studies revealed leukocytosis (272×109/L), thrombocytopenia (83×109/L) and no anemia, with 90% blasts in peripheral blood smear. The metabolic profile revealed a tumoral lysis syndrome and an elevated lactate dehydrogenase of 1877 U/L. The bone marrow aspirate showed 98-99% blasts cells of monocytic lineage while the flow cytometry analysis indicated 95% monocytic cells, positive for CD64+, CD33++, CD56+, CD36+ slab, CD300e-, CD14-, HLA-DR+. Normal karyotype, negative FISH for del 17p - TP53, and negative for the tested genes on RT-PCR (FLT3, RUNX1-RUNX1T1, CBFb-MYH11, MLL-AF9, PML-RARA), NGS negative (blood specimen). The patient had been successfully treated with conventional chemotherapy and underwent bone marrow transplantation from an unrelated donor with 100% donor chimerism at one year.t-AML only rarely presents with normal karyotype and there is a lack of clearly defined prognostic factors. Optimal treatment is still very much a matter of debate, in part because of the poor prognosis of the condition, and the only treatment with curative intent remains allogeneic hematopoietic stem cell transplantation.