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KMID : 1148920200540050256
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Nuclear Medicine and Molecular Imaging
2020 Volume.54 No. 5 p.256 ~ p.260
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Acute Promyelocytic Leukemia After Radium-223 Exposure for Prostate Cancer in a Chemotherapy-Naive Patient
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Perrone Salvatore
La Barbera Elettra Ortu
Ottone Tiziana
Capriata Marcello
Passucci Mauro
Filippi Luca
Bagni Oreste
Voso Maria Teresa
Cimino Giuseppe
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Abstract
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223Ra-dichloride is a bone-seeking targeted alpha (α)-emitting approved for bone metastases in prostate cancer. Here, we report a case of therapy-related acute promyelocytic leukemia (t-APL) following administration of 223Ra, showing some evidence of a causative relationship. A patient with metastatic prostate cancer received therapy with 223Ra, with 6 injections of the radiopharmaceutical at a standard dose of 55 kBq/kg at 4-week intervals for a cumulative administered activity of 26.3 MBq. PET/CT with 18F-methylcholine repeated 1 month after the conclusion of 223Ra was negative. After 8 months, he developed pancytopenia and we made a diagnosis of therapy-related acute promyelocytic leukemia (t-APL). We then studied the genomic locations of the breakpoints in the PML and RARA genes, which were at nucleotide positions 1708-09 of PML intron 3, respectively, outside the previously reported Topo II-associated hotspot region. t-APL was cured with all-trans-retinoic acid (ATRA) and arsenic trioxide. The type of PML/RARA rearrangement we identified, in absence of other myelotoxic treatments, is suggestive of a possible direct causal relationship with exposure to 223Ra and warrants further investigations.
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KEYWORD
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Acute promyelocytic leukemia, Prostate cancer. radium-223, Therapy-related acute myeloid leukemia
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