Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4579-4587
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4579
Therapy-related acute promyelocytic leukemia with FMS-like tyrosine kinase 3-internal tandem duplication mutation in solitary bone plasmacytoma: A case report
Li-Li Hong, Xian-Fu Sheng, Hai-Feng Zhuang
Li-Li Hong, Xian-Fu Sheng, Hai-Feng Zhuang, Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Zhuang HF conceived and designed the study; Hong LL wrote the paper; Sheng XF provided the picture and material support; all authors issued final approval for the version to be submitted.
Supported by Natural Science Foundation of Zhejiang Province, No. LY19H290003; Zhejiang Provincial Medical and Health Science and Technology Project, No. 2020KY196; and Foundation of Zhejiang Province Chinese Medicine Science and Technology Planes, No. 2017ZB030.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hai-Feng Zhuang, PhD, Associate Professor, Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310000, Zhejiang Province, China. Zhuanghaifeng5@163.com
Received: January 17, 2020
Peer-review started: January 17, 2020
First decision: August 21, 2020
Revised: September 1, 2020
Accepted: September 4, 2020
Article in press: September 4, 2020
Published online: October 6, 2020
Processing time: 254 Days and 10.5 Hours
Abstract
BACKGROUND

Therapy-related acute promyelocytic leukemia (t-APL) is a rare complication observed in solitary bone plasmacytoma (SBP), and SBP after radiotherapy evolving to APL harboring the FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation has never been reported. Here, we present the first case reported until now.

CASE SUMMARY

We describe a 64-year-old woman who presented with lumbar pain and was initially diagnosed with SBP. However, after one year of radiotherapy treatment, this patient experienced a long-standing bone-marrow-suppressive period and finally developed APL harboring the FLT3-ITD mutation, as confirmed by analyses of clinical features, bone marrow morphology, flow cytometry, cytogenetic examination, and molecular biology. On admission, the patient had disseminated intravascular coagulation and intracranial hemorrhage, and the peripheral blood and bone marrow smear displayed abundant abnormal promyelocytes. Unfortunately, she died when the definite diagnosis was made.

CONCLUSION

The patient with t-APL harboring FLT3-ITD mutation evolving from SBP after radiotherapy had not been reported and had poor clinical outcomes. FLT3-ITD mutation in t-APL may be a potential pathogenesis of leukemogenesis. We should consider the potential risk of secondary neoplasms in SBP patients after radiotherapy.

Keywords: Solitary bone plasmacytoma; Therapy-related acute promyelocytic; Leukemia; FMS-like tyrosine kinase 3-internal tandem duplication mutation; Radiotherapy; Cytopenia; Disseminated intravascular coagulation; Case report

Core Tip: We describe a 64-year-old woman presenting with lumbar pain who was initially diagnosed with solitary bone plasmacytoma (SBP), which finally developed into acute promyelocytic leukemia (APL) with FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutation after radiotherapy. To the best of our knowledge, this is the first report of t-APL with FLT3-ITD mutation in a patient with SBP treated with radiotherapy. The clinical outcome of t-APL with FLT3-ITD mutation secondary to SBP after radiotherapy was poor. We should consider the potential risk of secondary neoplasms in SBP patients after radiotherapy.