https://doi.org/10.4081/reumatismo.2023.1593
Emergence of acute promyelocytic leukemia in a patient with granulomatosis with polyangiitis during treatment with cyclophosphamide: a rare case report
Submitted: 11 May 2023
Accepted: 1 October 2023
Published: 19 December 2023
Accepted: 1 October 2023
Abstract Views: 1042
PDF: 250
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease that affects multiple organs and causes inflammation, necrosis, and vasculitis in small blood vessels. Treatment for GPA involves achieving and maintaining remission. In recent studies, cyclophosphamide-based regimens have been linked to comorbidity hazards, including an increased risk of malignancies, especially hematological ones. Acute myeloid leukemia is the main hematologic malignancy that can complicate GPA. In this context, we report the case of a middle-aged woman with GPA who developed acute promyelocytic leukemia (APL) during maintenance with cyclophosphamide. She was treated with all-trans retinoic acid at 50 mg/day and arsenic trioxide at 10 mg/day, along with steroids. This case highlights the unique emergence of APL in a GPA patient during cyclophosphamide therapy. A single case has previously been reported on the development of APL in a patient with GPA while using azathioprine monotherapy for 2 years.
Bacon PA. The spectrum of Wegener's granulomatosis and disease relapse. N Engl J Med 2005; 352: 330-2.
DOI: https://doi.org/10.1056/NEJMp048338
Polychronopoulos VS, Prakash UB, Golbin JM, Edell ES, Specks U. Airway involvement in Wegener's granulomatosis. Rheum Dis Clin North Am 2007; 33: 755-75, vi.
DOI: https://doi.org/10.1016/j.rdc.2007.09.004
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013; 65: 1-11.
DOI: https://doi.org/10.1002/art.37715
Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis 2016; 75: 1583-94. Erratum in: Ann Rheum Dis 2017; 76: 1480. Correction in: Ann Rheum Dis 2022; 81: e109.
DOI: https://doi.org/10.1136/annrheumdis-2016-209133
Faurschou M, Mellemkjaer L, Voss A, Keller KK, Hansen IT, Baslund B. Prolonged risk of specific malignancies following cyclophosphamide therapy among patients with granulomatosis with polyangiitis. Rheumatology 2014; 54: 1345-50.
DOI: https://doi.org/10.1093/rheumatology/keu372
Knight A, Hjorton K, Sundström C, Höglund M, Backlin C, Smedby KE, et al. Leukemia and myelodysplastic syndrome in granulomatosis with polyangiitis: subtypes, clinical characteristics, and outcome. J Rheumatol 2015; 42: 690-4.
DOI: https://doi.org/10.3899/jrheum.141104
Sumichika Y, Yokose K, Sato S, Saito K, Yoshida S, Matsumoto H, et al. Development of acute promyelocytic leukemia in a patient with granulomatosis with polyangiitis: a case report. Tohoku J Exp Med 2023; 259: 107-12.
DOI: https://doi.org/10.1620/tjem.2022.J098
Godman GC, Churg J. Wegener's granulomatosis: pathology and review of the literature. AMA Arch Pathol 1954; 58: 533-53.
Kubaisi B, Abu Samra K, Foster CS. Granulomatosis with polyangiitis (Wegener's disease): an updated review of ocular disease manifestations. Intractable Rare Dis Res 2016; 5: 61-9.
DOI: https://doi.org/10.5582/irdr.2016.01014
Sainz de la Maza M, Foster CS. Necrotizing scleritis after ocular surgery. A clinicopathologic study. Ophthalmology 1991; 98: 1720-6.
DOI: https://doi.org/10.1016/S0161-6420(91)32062-1
Shang W, Ning Y, Xu X, Li M, Guo S, Han M, et al. Incidence of cancer in ANCA-associated vasculitis: a meta-analysis of observational studies. PLoS One 2015; 10: e0126016.
DOI: https://doi.org/10.1371/journal.pone.0126016
Wang ZY, Chen Z. Acute promyelocytic leukemia: from highly fatal to highly curable. Blood 2008; 111: 2505-15.
DOI: https://doi.org/10.1182/blood-2007-07-102798
Lee SW, Park YB. Classification of antineutrophil cytoplasmic antibody-associated vasculitis. J Rheum Dis 2019; 26: 156-64.
DOI: https://doi.org/10.4078/jrd.2019.26.3.156
Esper GJ, Johnson JS. Update on the treatment of Wegener's granulomatosis. Bull Rheum Dis 1999; 48: 1-4.
De Groot K, Rasmussen N, Bacon PA, Tervaert JW, Feighery C, Gregorini G, et al. Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 2005; 52: 2461-9.
DOI: https://doi.org/10.1002/art.21142
How to Cite
Gorial, F., Awadh, N., Shaheen, N., Dheyaa, A., Ali, Z., & Wajdi, N. (2023). Emergence of acute promyelocytic leukemia in a patient with granulomatosis with polyangiitis during treatment with cyclophosphamide: a rare case report. Reumatismo, 75(4). https://doi.org/10.4081/reumatismo.2023.1593
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- M.G. Portuesi, M. Lancia, L. Ciuffreda, Problem of differential diagnosis between Crohn’s disease and colitis in Behçet’s disease: a case report , Reumatismo: Vol. 62 No. 2 (2010)
- A. Marino, T. Varisco, G. Quattrocchi, A. Amoroso, D. Beltrami, S. Venturiello, A. Ripamonti, A. Villa , M. Andreotti, M. Ciuffreda, R. Cimaz, Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C/PIMS) at the time of COVID-19: are they all the same? Case series and literature review , Reumatismo: Vol. 73 No. 1 (2021)
- L. Fioravante da Silveira, A. Zago, D. Zanchet, D. Chemello, Macrophage activation syndrome in a patient with systemic lupus erythematosus undergoing cyclophosphamide treatment: a case report , Reumatismo: Vol. 75 No. 2 (2023)
You may also start an advanced similarity search for this article.
