Acute leukemia after chemotherapy and/or radiotherapy for malignant disorder is called secondary acute leukemia(SAL) or therapy-related leukemia. Typically, SAL is preceded by a prodrome phase or myelodysplastic syndrome (MDS) resulting in
trilineage
dysplasia manifested by pancytopenia, associated with cytogenetic abnormalities involving chromosome 5 and 7, and carries a poor prognosis. Although FAB M3 type(acute promyelocytic leukemia) of SAL had been rarely reported, recently there was a
report
on 16 cases of therapy-related acute promyelocytic leukemia. We hereby report a case of secondary acute promyelocytic leukemia after treatment of advenced breast cancer. A 62-year-old woman was admitted because of pancytopenia, purpura of legs
and
gingival bleeding. Since six years before admission when she was diagnosed as infiltrating ductal carcinoma of breast with metastases to lung, She had received CMF(cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy and radiotherapy, and
underwent modified radical mastectomy after complete disappearance of pulmonary nodules. She had received further chemotherapy with cumulative doses of chemotherapeutic agents as following;21g of cyclophosphamide, 410mg of doxorubicin, 21g of
5-fluorouracil, and 600mg of methotrexate. Radiation doses to chest wall, axilla and supraclavicular area were 2880 to 3400cGy. The examination of bone marrow aspiration and biopsy showed acute promylocytic leukemia(FAB M3). Cytogenetic analysis
of
peripheral blood demonstrated 46XX[1]/46XX, t(7;11)(p15;p15)[12]. The patient did not achieved a complete remission despite retinoic acid therapy and intensive chemotherapy with Ara-C and AMSA, and died 10 months after diagnosis of acute
promyelocytic
leukemia.
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