Acute myeloid leukemia (AML) is a therapeutic challenge in elderly patients because of the biology of the leukemia and the poor functional status of the patient. Acute myeloid leukemia following previous treatment (t-AML) is defined as a separate subtype of AML, which is associated with the late effects of previous chemotherapy or radiotherapy. The therapeutic results of patients with t-AML are limited and optimal treatment in these patients is an even greater challenge.
Our patient is a 68-year-old woman who was hospitalized due to isolated anemia. The patient was diagnosed with breast cancer in 1996 and ovarian cancer in 2014, which were in remission at the time of the present hospitalization. Diagnostic procedures revealed therapy-related myelodysplastic syndrome (t-MDS) with a complex karyotype. The patient was stratified as high risk according to the revised IPSS. The patient received the best supportive care. Two months later, she was re-hospitalized due to fever, progressive weakness and fatigue, stomach discomfort, loss of appetite. Laboratory tests showed pancytopenia with 25% of myeloblasts in peripheral blood. The reassessment of the disease revealed evolution to t-AML with MDS-associated changes. Treatment with a hypomethylating agent was initiated. Unfortunately, the patient died with the symptoms of sudden cardiac death.
The therapeutic decision in elderly patients with t-AML is difficult and multifactorial. Combinations of already approved agents and new molecules will improve and diversify the therapeutic choices in elderly patients with high-risk AML.
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