Acute Promyelocytic Leukemia After Radium-223 Exposure for Prostate Cancer in a Chemotherapy-Naïve Patient
10.1007/s13139-020-00652-9
- Author:
Salvatore PERRONE
1
;
Elettra Ortu La BARBERA
;
Tiziana OTTONE
;
Marcello CAPRIATA
;
Mauro PASSUCCI
;
Luca FILIPPI
;
Oreste BAGNI
;
Maria Teresa VOSO
;
Giuseppe CIMINO
Author Information
1. Hematology, Polo Universitario Pontino, “Sapienza”, Via A. Canova S.M. Goretti Hospital, Latina, Italy
- Publication Type:CASE REPORT
- From:Korean Journal of Nuclear Medicine
2020;54(5):256-260
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
