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Gülden Sincan
Atatürk Üniversitesi Tıp Fak...
Yusuf Bilen
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Acute Promyelocytic Leukemia Associated with Theraphy of Mitoxantrone in Multiple Sclerosis

Promyelocytic Leukemia Associated with Mitoxantrone
Articles > Internal Medicine: Hematology
Submitted : 11.11.2015
Accepted : 08.02.2016
Published: 08.02.2016

Abstract

Mitoxantrone is a DNA-topoisomerase 2 inhibitor used for treatment of relapsing and progressive multiple sclerosis. Usage of mitoxantrone is limited, because of its potential risk such as cardiotoxicity and the induction of therapy-related acute leukemia. Acute promyelocytic leukemia with the translocation t(15;17) was over-represented in the multiple sclerosis population in comparison with cancer patients also treated with mitoxanrone. The timing of this complication, risk, mortality and relationship to exposure remain uncertain. Therefore, haematological monitoring should continue for at least 5 years after the last dose of mitoxantrone. In these report; we present a case with multiple sclerosis for 20 years. Pansitopenia developed in these patient after 17 months after receive the last dose of mitoxantrone (Cumulative dose:120 mg). We determined acute promyelocytic leukemia with labaratory finding. Remission induction chemotherapy and all-trans retinoic acid was administered to these patient. She was died because of pulmonary aspergillosis.
Keywords: Acute promyelocytic leukemia , Mitoxantrone , Multiple sclerosis

Özet

Mitoksantron, relaps ve progresif multiple sklerozis tedavisinde kullanılan bir DNA- topoizomeraz inhibitörüdür. Mitoksantron kullanımı, mitoksantronun kardiyotoksik ve tedavi-ilişkili akut lösemi potansiyel riskleri nedeniyle kısıtlıdır. Translokasyon (15,17) pozitif akut promyelosik lösemi mitoksantron kullanan kanser hastalarıyla karşılaştırıldırıldığında multipl sklerozisli hastalarda daha sık görülür. Bu komplikasyonun zamanı, riski, mortalitesi ve maruziyetle ilişkisi belirsizdir. Bu nedenle, mitoksantron son dozundan sonraki 5 yıl boyunca hematolojik monitorizasyon devam etmelidir. Bu çalışmada, biz 20 yıldır multipl sklerozis hastası olan bir olguyu sunuyoruz. Bu hastada mitoksantron tedavisinin son dozundan 17 ay sonra pansitopeni gelişti. Biz laboratuvar bulgularıyla akut promyelositik lösemi saptadık. Bu hastaya remisyon indüksiyon ve all-trans retinoik asit tedavisi başladık. Hasta pulmoner aspergillozis nedeniyle öldü.
Anahtar kelimeler: Akut promyelositik lösemi , Mitoksantron , Multipl sklerozis
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