Acute Myeloid Leukemia After Treatment of Early Breast Cancer: Case Report and Literature Review

  • Issam LalyaEmail author
  • Ismail Essadi
  • Rhizlane Belbaraka
  • Abdelhamid El Omrani
  • Mouna Khouchani
Case Report



Therapy-related acute myeloid leukemia has been widely accepted for decades as one of the most serious long-term complications of treatment for early breast cancer.


We report the case of a patient with therapy-related acute myeloid leukemia that may have been caused by regional radiation, chemotherapy, or endocrine therapy after surgery. A 35-year-old female was diagnosed 7 years ago as having stage IIA left breast cancer; she was treated by conservative surgery, followed by chemotherapy, radiotherapy, and endocrine therapy for 5 years. After 1 year of active follow-up, she presented with complaints of mild fever, weakness, loss of appetite, weight loss, and multiple bruises all over the body. Complete blood count revealed a hemoglobin level of 4 g/dl and total leukocyte count of 40,000 cells/mm3, with multiple blast cells in peripheral smear. Bone marrow biopsy and immunophenotyping established the diagnosis as AML. Before starting the treatment, she died following multiple organ failure.


Therapy-related acute myeloid leukemia Chemotherapy Radiotherapy Endocrine therapy Breast cancer 



Special thanks are due to the Faculty of Medicine and Pharmacy of Marrakech and Cadi Ayyad University of Marrakech.

Authors’ contributions

IL and IE performed the research and wrote the manuscript. RB, AE, and MK coordinated the research and revised and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Granfeldt Østgård LS, Medeiros BC, Sengeløv H, et al. Epidemiology and clinical significance of secondary and therapy-related acute myeloid leukemia: a national population-based cohort study. J Clin Oncol. 2015;33:3641.CrossRefGoogle Scholar
  2. 2.
    Schaapveld M, Visser O, Louwman MJ, et al. Risk of new primary nonbreast cancers after breast cancer treatment: a Dutch population-based study. J Clin Oncol. 2008;26:1239.CrossRefGoogle Scholar
  3. 3.
    Matesich SM, Shapiro CL. Second cancers after breast cancer treatment. Semin Oncol. 2003;30:740.CrossRefGoogle Scholar
  4. 4.
    Rubagotti A, Perrotta A, Casella C, Boccardo F. Risk of new primaries after chemotherapy and/or tamoxifen treatment for early breast cancer. Ann Oncol. 1996;7:239.CrossRefGoogle Scholar
  5. 5.
    Larson RA. Etiology and management of therapy-related myeloid leukemia. Hematol Am Soc Hematol Educ Progr. 2007;2007:453–9.CrossRefGoogle Scholar
  6. 6.
    Smith RE, Bryant J, DeCillis A, Anderson S. Acute myeloid leukemia and myelodysplastic syndrome after doxorubicin-cyclophosphamide adjuvant therapy for operable breast cancer: the National Surgical Adjuvant Breast and Bowel Project experience. J Clin Oncol. 2003;21:1195–204.CrossRefGoogle Scholar
  7. 7.
    Godley LA, Larson RA. Therapy-related myeloid leukemia. Semin Oncol. 2008;35(4):418–29.CrossRefGoogle Scholar
  8. 8.
    Hershman D, Neugut AI, Jacobson JS, et al. Acute myeloid leukemia or myelodysplastic syndrome following use of granulocyte colony-stimulating factors during breast cancer adjuvant chemotherapy. J Natl Cancer Inst. 2007;99:196–205.CrossRefGoogle Scholar
  9. 9.
    Le Deley MC, Suzan F, Cutuli B, et al. Anthracyclines, mitoxantrone, radiotherapy, and granulocyte colony-stimulating factor: risk factors for leukemia and myelodysplastic syndrome after breast cancer. J Clin Oncol. 2007;25:292–300.CrossRefGoogle Scholar
  10. 10.
    Ono M, Watanabe T, Shimizu C, Hiramoto N, Goto Y, Yonemori K, Kouno T, Ando M, Tamura K, Katsumata N, Fujiwara Y. Therapy-related acute promyelocytic leukemia caused by hormonal therapy and radiation in a patient with recurrent breast cancer. Jpn J Clin Oncol. 2008;38(8):567–70. Scholar
  11. 11.
    Yalcin S, Gullu I, Demiroglu H, Tekuzman G. Acute leukemia during tamoxifen therapy. Med Oncol. 1997;14:61–2.CrossRefGoogle Scholar
  12. 12.
    Rutqvist LE, Johansson H, Signomklao T, Johansson U, Fornander T, Wilking N. Adjuvant tamoxifen therapy for early stage breast cancer and second primary malignancies. J Natl Cancer Inst. 1995;87:645–51.CrossRefGoogle Scholar
  13. 13.
    Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet. 1998;351:1451–67.CrossRefGoogle Scholar
  14. 14.
    Haas JF, Kittelmann B, Mehnert WH, Staneczek W, Mohner M, Kaldor JM, et al. Risk of leukaemia in ovarian tumour and breast cancer patients following treatment by cyclophosphamide. Br J Cancer. 1987;55:213–8.CrossRefGoogle Scholar
  15. 15.
    Godley LA, Larson RA. The syndrome of therapy-related myelodysplasia and myeloid leukemia. In: Bennett JM, editor. The myelodysplastic syndromes: pathobiology and clinical management. New York: Marcel Dekker, Inc.; 2002. p. 139–76.Google Scholar
  16. 16.
    Anderson JE, Gooley TA, Schoch G, et al. Stem cell transplantation for secondary acute myeloid leukemia: evaluation of transplantation as initial therapy or following induction chemotherapy. Blood. 1997;89:2578–85.PubMedGoogle Scholar

Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  1. 1.Radiation-Oncology DepartmentMohammed VI University HospitalMarrakechMorocco
  2. 2.Faculty of Medicine and PharmacyCadi Ayyad UniversityMarrakechMorocco
  3. 3.Medical Oncology DepartmentAvicenne Military HospitalMarrakechMorocco
  4. 4.Medical Oncology DepartmentMohammed VI University HospitalMarrakechMorocco

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