J Breast Cancer.  2020 Feb;23(1):100-106. 10.4048/jbc.2020.23.e1.

Acute Lymphoblastic Leukemia in a Patient Treated with Letrozole and Palbociclib

  • 1Division of Hematology-Medical Oncology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. jinhyunpak@gmail.com
  • 2Department of Laboratory Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Pathology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.


Palbociclib, in conjunction with endocrine therapy, has been approved for the treatment of patients with advanced breast cancer. The common hematological toxicities associated with palbociclib are leukopenia and neutropenia. However, hematological malignancies have not been reported for palbociclib treatment. Here, for the first time, we present a case of acute lymphoblastic leukemia that was diagnosed in a patient undergoing treatment with letrozole and palbociclib for metastatic breast cancer. This case emphasizes the need for long term follow up of patients treated with palbociclib.


Adverse effects; Breast neoplasms; Hematologic neoplasms; Palbociclib; Precursor cell lymphoblastic leukemia-lymphoma

MeSH Terms

Breast Neoplasms
Follow-Up Studies
Hematologic Neoplasms
Precursor Cell Lymphoblastic Leukemia-Lymphoma*


  • Figure 1 Images of breast cancer (A) Mammogram showing an irregular high density mass in the upper region of the left breast (indicated by arrows). (B) Ultrasonography image showing a microlobulating irregular hypoechoic mass at the 12 o'clock position. (C) 18F-fluorodeoxyglucose positron emission tomography/computed tomography image demonstrating hypermetabolism in the mass in the left breast and diffuse bone.

  • Figure 2 Histopathological findings of breast cancer. (A) Hematoxylin-eosin staining showing invasive ductal carcinoma at a magnification of 100×. (B-D) The results of immunohistochemistry revealed that the tumor was estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative (magnification 100×).

  • Figure 3 Histology of bone marrow biopsy and 18F-FDG PET/CT scan of acute lymphoblastic leukemia (A) Bone marrow examination showing abnormal lymphocytes with hematoxylin-eosin staining, at a magnification of 400×, (B) 18F-FDG PET/CT image demonstrating diffuse hypermetabolism along the whole axial and appendicular bones and spleen with no residual hypermetabolism in the mass in the left breast. FDG = fluorodeoxyglucose; PET/CT = positron emission tomography/computed tomography.


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