Epipodophyllotoxin-related leukemia after Langerhans Cell Histiocytosis: A case report

N. El Banna, Z. Al-Lamki, E. T. Smigura, Y. Wali, D. Dennison

Research output: Contribution to journalArticle

Abstract

The spectrum of side effects induced by Etoposide (VP16) includes myelosuppression, nausea and vomiting, mucocutaneous effects, hepato-toxicity and rarely allergic reactions. Recent reports have documented acute myeloid leukemia (AML) following therapy with epipodophyllotoxins. We report a case of VP16 related AML in a child with Langerhans Cell Histiocytosis (LCH). She demonstrated a disease regression with VP16 at a cumulative dose of 6000 mg/m2 after having failed to respond to a multi-agent regimen containing prednisolone, vincristine, methotrexate and 6 Mercatopurine. At 3 1/2 years after starting treatment with VP16 she developed therapy-related leukemia; AML, M3 with t(15;17). The picture was similar to that reported by Haupt and co-workers in the Italian cohort study. Although VP16 is an effective treatment in multisystem disease we hereby further suggest that high total cumulative dose of over 4000 mg/m2 may increase the risk of abnormality on chromosome 15 and 17 with the resultant development of secondary acute promyelocytic Leukemia (APL). This observation applies not only to the Italian and Latino population but also to other ethnic groups such as two other cases reported by Horbe, K., Matsushita, T., Numata, S. et al. Cancer, 72(12), 3723-6 and our patient who is the only case report of an Arab origin. She attained remission with antileukemic therapy followed by a successful outcome from bone marrow transplantation (BMT).

Original languageEnglish
Pages (from-to)15-19
Number of pages5
JournalInternational Journal of Pediatric Hematology/Oncology
Volume6
Issue number1
Publication statusPublished - 1999

Fingerprint

Podophyllotoxin
Langerhans Cell Histiocytosis
Leukemia
Acute Promyelocytic Leukemia
Acute Myeloid Leukemia
Therapeutics
Chromosomes, Human, Pair 15
Chromosomes, Human, Pair 17
Vincristine
Etoposide
Prednisolone
Bone Marrow Transplantation
Hispanic Americans
Ethnic Groups
Methotrexate
Nausea
Vomiting
Hypersensitivity
Cohort Studies
Population

Keywords

  • Bone marrow transplantation (BMT)
  • High dose Etoposide (VP16)
  • Langerhans Cell Histiocytosis (LCH)
  • Therapy induced acute myeloid leukemia (t-AML)
  • Therapy related M with t(15; 17)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Cancer Research

Cite this

Epipodophyllotoxin-related leukemia after Langerhans Cell Histiocytosis : A case report. / El Banna, N.; Al-Lamki, Z.; Smigura, E. T.; Wali, Y.; Dennison, D.

In: International Journal of Pediatric Hematology/Oncology, Vol. 6, No. 1, 1999, p. 15-19.

Research output: Contribution to journalArticle

@article{fbe3257a24d5432d8f9d71164d2735f8,
title = "Epipodophyllotoxin-related leukemia after Langerhans Cell Histiocytosis: A case report",
abstract = "The spectrum of side effects induced by Etoposide (VP16) includes myelosuppression, nausea and vomiting, mucocutaneous effects, hepato-toxicity and rarely allergic reactions. Recent reports have documented acute myeloid leukemia (AML) following therapy with epipodophyllotoxins. We report a case of VP16 related AML in a child with Langerhans Cell Histiocytosis (LCH). She demonstrated a disease regression with VP16 at a cumulative dose of 6000 mg/m2 after having failed to respond to a multi-agent regimen containing prednisolone, vincristine, methotrexate and 6 Mercatopurine. At 3 1/2 years after starting treatment with VP16 she developed therapy-related leukemia; AML, M3 with t(15;17). The picture was similar to that reported by Haupt and co-workers in the Italian cohort study. Although VP16 is an effective treatment in multisystem disease we hereby further suggest that high total cumulative dose of over 4000 mg/m2 may increase the risk of abnormality on chromosome 15 and 17 with the resultant development of secondary acute promyelocytic Leukemia (APL). This observation applies not only to the Italian and Latino population but also to other ethnic groups such as two other cases reported by Horbe, K., Matsushita, T., Numata, S. et al. Cancer, 72(12), 3723-6 and our patient who is the only case report of an Arab origin. She attained remission with antileukemic therapy followed by a successful outcome from bone marrow transplantation (BMT).",
keywords = "Bone marrow transplantation (BMT), High dose Etoposide (VP16), Langerhans Cell Histiocytosis (LCH), Therapy induced acute myeloid leukemia (t-AML), Therapy related M with t(15; 17)",
author = "{El Banna}, N. and Z. Al-Lamki and Smigura, {E. T.} and Y. Wali and D. Dennison",
year = "1999",
language = "English",
volume = "6",
pages = "15--19",
journal = "International Journal of Pediatric Hematology/Oncology",
issn = "1070-2903",
publisher = "Taylor and Francis Ltd.",
number = "1",

}

TY - JOUR

T1 - Epipodophyllotoxin-related leukemia after Langerhans Cell Histiocytosis

T2 - A case report

AU - El Banna, N.

AU - Al-Lamki, Z.

AU - Smigura, E. T.

AU - Wali, Y.

AU - Dennison, D.

PY - 1999

Y1 - 1999

N2 - The spectrum of side effects induced by Etoposide (VP16) includes myelosuppression, nausea and vomiting, mucocutaneous effects, hepato-toxicity and rarely allergic reactions. Recent reports have documented acute myeloid leukemia (AML) following therapy with epipodophyllotoxins. We report a case of VP16 related AML in a child with Langerhans Cell Histiocytosis (LCH). She demonstrated a disease regression with VP16 at a cumulative dose of 6000 mg/m2 after having failed to respond to a multi-agent regimen containing prednisolone, vincristine, methotrexate and 6 Mercatopurine. At 3 1/2 years after starting treatment with VP16 she developed therapy-related leukemia; AML, M3 with t(15;17). The picture was similar to that reported by Haupt and co-workers in the Italian cohort study. Although VP16 is an effective treatment in multisystem disease we hereby further suggest that high total cumulative dose of over 4000 mg/m2 may increase the risk of abnormality on chromosome 15 and 17 with the resultant development of secondary acute promyelocytic Leukemia (APL). This observation applies not only to the Italian and Latino population but also to other ethnic groups such as two other cases reported by Horbe, K., Matsushita, T., Numata, S. et al. Cancer, 72(12), 3723-6 and our patient who is the only case report of an Arab origin. She attained remission with antileukemic therapy followed by a successful outcome from bone marrow transplantation (BMT).

AB - The spectrum of side effects induced by Etoposide (VP16) includes myelosuppression, nausea and vomiting, mucocutaneous effects, hepato-toxicity and rarely allergic reactions. Recent reports have documented acute myeloid leukemia (AML) following therapy with epipodophyllotoxins. We report a case of VP16 related AML in a child with Langerhans Cell Histiocytosis (LCH). She demonstrated a disease regression with VP16 at a cumulative dose of 6000 mg/m2 after having failed to respond to a multi-agent regimen containing prednisolone, vincristine, methotrexate and 6 Mercatopurine. At 3 1/2 years after starting treatment with VP16 she developed therapy-related leukemia; AML, M3 with t(15;17). The picture was similar to that reported by Haupt and co-workers in the Italian cohort study. Although VP16 is an effective treatment in multisystem disease we hereby further suggest that high total cumulative dose of over 4000 mg/m2 may increase the risk of abnormality on chromosome 15 and 17 with the resultant development of secondary acute promyelocytic Leukemia (APL). This observation applies not only to the Italian and Latino population but also to other ethnic groups such as two other cases reported by Horbe, K., Matsushita, T., Numata, S. et al. Cancer, 72(12), 3723-6 and our patient who is the only case report of an Arab origin. She attained remission with antileukemic therapy followed by a successful outcome from bone marrow transplantation (BMT).

KW - Bone marrow transplantation (BMT)

KW - High dose Etoposide (VP16)

KW - Langerhans Cell Histiocytosis (LCH)

KW - Therapy induced acute myeloid leukemia (t-AML)

KW - Therapy related M with t(15; 17)

UR - http://www.scopus.com/inward/record.url?scp=0032966656&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032966656&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:0032966656

VL - 6

SP - 15

EP - 19

JO - International Journal of Pediatric Hematology/Oncology

JF - International Journal of Pediatric Hematology/Oncology

SN - 1070-2903

IS - 1

ER -