Haematology. Barbara J. Bain

      Therapy‐related AML is an unfortunate consequence of bone marrow exposure to chemotherapy or radiotherapy used as treatment for neoplastic disease in haematology and oncology practice. As more of these conditions are cured with modern therapy, often using a combination of surgery, chemotherapy and radiotherapy, in breast cancer for example, more patients are surviving to develop therapy‐related myeloid neoplasms. It is not uncommon within haematology to see therapy‐related AML resulting from treatment of another haematological disease, as in the patient described here. We have seen such cases as a result of previous successful treatment for Hodgkin lymphoma, diffuse large B‐cell lymphoma, blastic plasmacytoid dendritic cell neoplasm and acute promyelocytic leukaemia. To be cured of a good‐prognosis leukaemia and develop a poor‐prognosis leukaemia as a consequence is particularly difficult to face.

MCQ

      1 Therapy‐related acute leukaemia:Can be associated with 5q−, monosomy 5, 7q− and monosomy 7Can be lymphoblastic or myeloidHas an equally poor prognosis, regardless of the causative agent, the blast percentage or any cytogenetic abnormalities presentHas identical characteristics whether it follows alkylating agents or topoisomerase II inhibitorsIncreases in incidence with the age of exposure to the causative agentFor answers and discussion, see page 206.