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Potential impact of the hypomethylating agent 5-azacitidine on chronic lymphocytic leukemia with del(17)(p)/del(p53) and subsequent therapy-related acute myeloid leukemia without these aberrations: a case report

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Abstract

The patient presented here had a very poor prognosis due to previous chronic lymphocytic leukemia with unfavourable cytogenetics (deleted 17p and p53), therapy-related acute myeloid leukemia (intact 17p/p53), multiple pre-treatments (fludarabine, rituximab-CHOP, rituximab-bendamustine), advanced age (71 years) and several comorbidities—circumstances that usually do not allow high-dose chemotherapy or stem cell transplantation. Due to this unfavourable condition and reportedly poorer outcome of therapy-related acute myeloid leukemia relative to de novo acute myeloid leukemia with chemotherapy, treatment with the hypomethylating agent 5-azacitidine (Vidaza®), 75 mg/m2/day, subcutaneously for 7 days of 28-day cycles was started. Therapy was well tolerated and yielded a good response not only by eradicating the therapy-related acute myeloid leukemia but also by keeping the chronic lymphocytic leukemia under control for a rather long period of time. The simultaneous suppression and re-appearance of both the therapy-related acute myeloid leukemia with intact p53 and the chronic lymphocytic leukemia with deleted p53 suggests that hypomethylation by azacitidine attains tumour control by a mechanism that (i) is similar in the different tumours and (ii) acts independently of the p53 status. This case may serve as a model for disease progression mirrored in molecular and cytogenetic findings which are factored into treatment decisions.

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Acknowledgements

The authors received editorial support in the preparation of this manuscript from Eva Müller PhD of [Life Science Texte], funded by Celgene Corporation. The authors directed were fully responsible for all content and editorial decisions for this manuscript.

Informed consent

Oral informed consent was obtained from the patient described in this case report.

Conflict of interest

First author has received speaker honoraria and consultancy fees from Celgene, all other authors have no conflict of interest to declare.

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Authors and Affiliations

  1. 3rd Department of Medicine, Hanusch Hospital, Heinrich-Collin-Straße 30, 1140, Vienna, Austria

    Michael Pfeilstöcker MD, MBA, Elisabeth Menschel MD & Felix Keil MD

  2. Institute of Pathology, Hanusch Hospital, Vienna, Austria

    Rainer Weichselbaum MD

  3. Center for Medical Genetics, Hanusch Hospital, Vienna, Austria

    Helmut Mühlberger

Authors
  1. Michael Pfeilstöcker MD, MBA
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  2. Rainer Weichselbaum MD
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  3. Helmut Mühlberger
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  4. Elisabeth Menschel MD
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  5. Felix Keil MD
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Corresponding author

Correspondence to Michael Pfeilstöcker MD, MBA.

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Pfeilstöcker, M., Weichselbaum, R., Mühlberger, H. et al. Potential impact of the hypomethylating agent 5-azacitidine on chronic lymphocytic leukemia with del(17)(p)/del(p53) and subsequent therapy-related acute myeloid leukemia without these aberrations: a case report. memo 8, 144–147 (2015). https://doi.org/10.1007/s12254-015-0201-0

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  • DOI: https://doi.org/10.1007/s12254-015-0201-0

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