SECONDARY ACUTE PROMYELOCYTIC LEUKEMIA DEVELOPED AFTER TREATMENT OF NON-HODGKIN'S LYMPHOMA. CLINICAL CASE AND REVIEW OF LITERATURE.

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Background: Acute promyelocytic leukemia is an acute myeloid leukemia that accounts approximately 10% of acute myeloid leukemia cases. Acute promyelocytic leukemias usually appears as a de novo finding. The occurrence of secondary acute promyelocytic leukemias after chemotherapy is rare, and the development of secondary acute promyelocytic leukemias after an non-Hodgkin lymphoma is casuistic. The objective of the study is to describe a case of secondary acute promyelocytic leukemia developed  after non-Hodgkin lymphoma therapy

Clinical case: Male B, 34 years old, hospitalized in a critical condition in the Hematological Center of the Institute of Oncology, Chișinău, Republic of Moldova, with diffuse large B cell lymphoma, stage IV B, X (Ann-Arbor). With the purpose of remission induction, 15 cycles of chemotherapy were performed( 12 cycles of remission induction, 3 cycles of mentainence therapy)  obtaining a partial remission. 25 months after the onset of the non-Hodgkin lymphoma, the patient experienced: anemia, thrombocytopenia and leukocytosis associated with peripheral blastosis. For restadialization a bone marrow aspiration was performed, which reveals 95% of promyelocyte-type blasts. Secondary acute promyelocytic leukemia was confirmed, remission induction chemotherapy was initiated, but, still the result proved no efficacy. The death occurred early in induction, which corresponds with literature data.

Conclusion: Secondary acute promyelocytic leukemias developed after non-Hodgkin lymphomas therapies are rare nosological entities in clinical practice, which are associated with the negative effect of treatment with anthracyclines or tenoposide derivatives, resulting in unfavorable prognosis and high mortality.