Acute Promyelocytic Leukemia Developed during Imatinib Therapy for Gastrointestinal Stromal Tumors

• Published in: Zhongguo shi yan xue ye xue za zhi Vol. 25; no. 2; p. 358
• Main Authors: Yu, Ya-Ping, Song, Ping, Mei, Jian-Gang, An, Zhi-Ming, Zhou, Xiao-Gang, Li, Feng, Wang, Li-Ping, Tang, Yu-Mei, Zhai, Yong-Ping
• Format: Journal Article
• Language: Chinese
• Published: China 01.04.2017
• Subjects: Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Female; Gastrointestinal Stromal Tumors - drug therapy; Humans; Imatinib Mesylate - adverse effects; Imatinib Mesylate - therapeutic use; Leukemia, Promyelocytic, Acute - chemically induced; Middle Aged; Neoplasms, Second Primary - chemically induced; Oncogene Proteins, Fusion; Tretinoin
• ISSN: 1009-2137
• DOI: 10.7534/j.issn.1009-2137.2017.02.009

To investigate the clinicopathologic and molecular characteristics of acute promyelocytic leukemia(APL) developed during imatinib therapy for gastrointestinal stromal tumors(GIST). A 49-year-old woman was hospitalized for abdominal pain. The abdominal CT revealed a gastric mass. Laparoscopic resection of the tumor was performed. The histopathologic analysis showed poorly differentiated malignant cell infiltration with epithelioid features. Immunohistochemistry staining of these cells was positive for CD117 and CD34. GIST was confirmed and imatinib treatment was given. After 1 year,the patient developed progressive pancytopenia. Bone marrow aspirate showed marked hyperplasia of bone marrow cells with 92.5% promyelocyte, consistent with APL. Cytogenetic analysis demonstrated t(15;17)(q22;q21) as the sole abnormality. PML/RARα fusion gene was positive and Kit mutation was negative. After combined treatment with ATRA, arsenic trioxide and idarubicin, patient achieved cytogenetic and molecular remission. The metac