Korean J Hematol.  2006 Dec;41(4):302-305. 10.5045/kjh.2006.41.4.302.

A Case of Acute Promyelocytic Leukemia after Iodine-131 Treatment for Thyroid Cancer

• Lee SH
• Eom KS
• Lee S
• Kim HJ
• Min CK
• Kim SY
• Cho BS
• Lee H
• Park CK
• Cho SG
• Kim DW
• Lee JW
• Min WS
• Kim CC

• KMID: 2305218
• DOI: http://doi.org/10.5045/kjh.2006.41.4.302

Abstract

Radioactive iodine (131I) has been used in the treatment of thyroid cancer to eliminate residual thyroid tissue after thyroidectomy and to treat metastatic disease. Leukemia has rarely been reported as a late complication of 131I therapy, occurring most frequently after receiving a cumulative activity of 800 mCi of the radioisotope. Although FAB M3 type (acute promyelocytic leukemia, APL) as the secondary acute leukemia had been rarely reported, recently there have been a few cases of therapy-related APL leukemia seen. We hereby report a case of secondary acute promyelocytic leukemia occurring in a patient who received radioactive iodine therapy for papillary thyroid carcinoma. An assessment of causality using the Naranjo probability scale showed that a possible relationship existed between APL seen in the patient and the use of the radioactive iodine. Although this is a very rare event, strict hematologic follow-up of patients treated with radioactive iodine may be warranted, along with a high index of suspicion in those with coagulopathy.

Keyword

Acute promyelocytic leukemia; Radioactive iodine; Secondary AML

MeSH Terms

Follow-Up Studies
Humans
Iodine
Leukemia
Leukemia, Promyelocytic, Acute*
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Iodine

Figure

• 

  Fig. 1 Bone marrow aspiration findings shows leukemic cells showing medium to large sized, round to oval or irregularly shaped, finely chromatinated nuclei with or without distinct nucleoli, and moderate amount of blue cytoplasm with numerous azurophilic granules (×1,000).

Reference

1). Pedersen-Bjergaard J., Andersen MK., Christiansen DH., Nerlov C. Genetic pathways in therapy-related myelodysplasia and acute myeloid leukemia. Blood. 2002. 99:1909–12.

2). de Vathaire F., Schlumberger M., Delisle MJ, et al. Leukemias and cancers following iodine-131 administration for thyroid cancer. Br J Cancer. 1997. 75:734–9.

3). Lichtman MA., Henderson ES. Acute myelogenous leukemia. William JW, Beutler E, Erslev AJ, Lichtman MA, editors. Hematology. 7th ed.New York: McGraw Publishing Company;2006. p. 1203–4.

4). Ko TY., Kwag JS., Oh KS, et al. Acute myelogenous leukemia developed after radioactive iodine therapy and palliative radiation therapy in metastatic papillary thyroid cancer. Korean J Nucl Med. 1998. 32:436–42.

5). Baldet L., Manderscheid JC., Glinoer D., Jaffiol C., Coste-Seignovert B., Percheron C. The management of differentiated thyroid cancer in Europe in 1988. Results of an international survey. Acta Endocrinol (Copenh). 1989. 120:547–58.

6). Maxon HR., Thomas SR., Chen IW. The role of nuclear medicine in the treatment of hyperthyroidism and well-differentiated thyroid adenocarcinoma. Clin Nucl Med. 1981. 6:87–98.

7). Freitas JE., Gross MD., Ripley S., Shapiro B. Radionuclide diagnosis and therapy of thyroid cancer: current status report. Semin Nucl Med. 1985. 15:106–31.

8). Greaves MF. Aetiology of acute leukemia. Lancet. 1997. 349:344–9.

9). Bitton R., Sachmechi I., Benegalrao Y., Schneider BS. Leukemia after a small dose of radioiodine for metastatic thyroid cancer. J Clin Endocrinol Metab. 1993. 77:1423–6.

10). Hall P., Boice JD Jr., Berg G, et al. Leukaemia incidence after iodine-131 exposure. Lancet. 1992. 340:1–4.

11). Brincker H., Hansen HS., Andersen AP. Induction of leukemia by 131-treatment of thyroid carcinoma. Br J Cancer. 1973. 28:232–7.

12). Richards EM., Marcus RE. Acute promyelocytic leukemia following radioiodine therapy. Clin Lab Hae-matol. 1993. 15:55–8.

13). Pedersen-Bjergaard J., Philip P., Larsen SO., Jensen G., Byrsting K. Chromosome aberrations and prognostic factors in therapy-related myelodysplasia and acute nonlymphocytic leukemia. Blood. 1990. 76:1083–91.

14). Detourmignies L., Castaigne S., Stoppa AM, et al. Therapy-related acute promyelocytic leukemia: a report on 16 cases. J Clin Oncol. 1992. 10:1430–5.

15). Naranjo CA., Busto U., Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981. 30:239–45.