Therapy-Related Acute Myeloid Leukemia Following HIV-Associated Lymphoma

In the highly active antiretroviral therapy era, an increasingly large number of HIV-infected patients are developing non—AIDS-defining cancers (NADCs). As patients survive longer, long-term therapy—related complications take on greater importance. Herein, we describe a patient with AIDS who presented to medical attention with pancytopenia 48 months postchemotherapy with etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (R-EPOCH) for diffuse large B-cell lymphoma. Bone marrow biopsy showed a moderately hypocellular marrow; 51% of the nucleated cells were blasts with myelomonocytic differentiation. Cytogenetic studies revealed an abnormal karyotype with deletion of the long arm of chromosome 11 (11_q21) and 2 additional copies of the MLL gene attached to the short arms of chromosome 10 in 80% of the metaphase cells examined. With the diagnosis of therapy-related acute myeloid leukemia (AML) secured, he began induction chemotherapy with idarubicin and cytarabine. Two weeks later, he died of fungal septicemia and multiorgan failure. Through a literature search, we were able to identify 4 additional cases of therapy-related AML in AIDS patients following chemotherapy for lymphomas. The median age of these patients at the time of AML diagnosis was 39 years (range, 33–59 years), the median time from the treatment of lymphoma to AML was 18 months (range, 11–48 months), and the median survival following induction chemotherapy was 4 weeks (range, 2–16 weeks). With many HIV-infected patients surviving alkylator and topoisomerase inhibitor—based treatment and radiation therapy for AIDS-defining cancers and NADCs, long-term follow-up for therapy-related complications assumes greater importance.