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Acute myeloid leukaemia in a 19 year old patient previously treated for osteosarcoma

Dragan C., Meilin Murat, Trifa A., Tevet Mihaela, Lupu Anca Roxana
Abstract: As patients with osteosarcoma become long-term survivors, increasing attention revolved around the burden of late effects. Recent studies showed an increase in the incidence of secondary malignant neoplasms in patients with osteosarcoma compared with the general population. The risk of developing leukaemia was reported to be in an increasing rate in the last decade. [1] Case report. In this report we present the case of a 19 year old patient diagnosed in the Haematology Department of Colentina Clinical Hospital in February 2015 with Acute Myeloid Leukaemia following the treatment (chemo- and radio-therapy) for an osteogenic osteosarcoma performed 3 years earlier. The cytogenetic examination revealed an abnormal karyotype with 91 chromosomes (XXY). The molecular biology exam did not find mutations in the FLT3ITD, FLT3D835 and NPM1 A genes. After the first induction course of chemotherapy the patient achieved complete remission, which was consolidated by 3 more courses of chemotherapy and an allogeneic stem cell transplant. Conclusion. Taking into consideration the prior treatment for osteosarcoma consisting in radiotherapy and chemotherapy we identified a secondary Acute Myeloid Leukaemia, this representing a major negative prognostic factor, along with the cytogenetic abnormalities found. These factors strongly indicate that the first complete remission should be consolidated by allogeneic stem cell transplant. Particularities of this case are the association of the two malignancies in a young patient, the presence of an abnormal karyotype (hyperploid), and also a good response to the induction therapy, thus achieving complete remission after the first induction course, and of course, sustaining that response.

Keywords: secondary leukemia, osteosarcoma, cytogenetics, complete remission


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