Acute promyelocytic leukaemia (APL) in a patient with Crohn's disease and exposure to infliximab: a rare clinical presentation and review of the literature

Abstract

With the introduction of potent immunosuppressive and chemotherapeutic medications for various diseases, there is an increased incidence of therapy-related myeloid neoplasms. They are the result of mutational rearrangement and historically, have a grave prognosis compared with de novo myeloid neoplasms. We did a short review on various types of myeloid leukaemias reported after therapy with antitumour necrosis factor and also report, to the best of our knowledge, one among the very few cases of therapy-related acute promyelocytic leukaemia in a patient on infliximab therapy for refractory Crohn's disease. The patient responded well to the traditional treatment and is in complete remission for more than 5 years.

Acute Myeloid Leukemia with Myelodysplasia-Related Changes in a Patient with Crohn’s Disease Treated with Immunosuppressive Therapy

“…Anti-TNF is increasingly used for treating CD. It is noteworthy that, similar to our case, there have been reports of acute leukemia in patients with CD or other autoimmune diseases with the use of anti-TNF drugs [ 4 , 5 , 6 , 7 ]. These cases may raise a concern of anti-TNF drugs potentiating leukemia.…”

Acute Promyelocytic Leukemia in a Patient With Chronic Continuous Type of Crohn’s Disease

“…However, our patient developed APL even though he had not received thiopurines. Four patients of six previous APL cases associated with Crohn's disease received conventional treatment without thiopurines and another patient received multiple small bowel resections and colostomy (Table 2) [11][12][13][14][15]. Only one patient was treated with thiopurines.…”

“…In conclusion, our patient developed APL although he had never received thiopurines which are known to be associated with an increased risk of development of myeloid neoplasms. To the best of our knowledge, there are a few case reports of APL in patients with Crohn's disease [11][12][13][14][15]. Although further investigations are needed to certify the association between Crohn's disease and APL occurrence, careful attention should be paid to the development of myeloid neoplasms in Crohn's disease patients with long-term active inflammation.…”

“…In particular, an almost six times higher association between IBD and hematological malignancies has been reported in patients with Crohn's disease as compared to the general population [10]. There are a few reports of secondary APL in patients with Crohn's disease [11][12][13][14][15].…”

Acute Promyelocytic Leukemia After Renal Transplant and Filgrastim Treatment for Neutropenia

“…Th erapy-related APLs have been reported in chronically immunosuppressed patients, including a patient with Crohn's disease and liver and kidney transplant recipients (8)(9)(10)(11)(12). Cytotoxic antimetabolites such as mycophenolate, used in many immunosuppressive regimens, have been implicated in the development of secondary APL following renal transplantation ( 1,8,10 ).…”