Therapy‐related leukaemia cutis: A review

Abstract

Leukaemia cutis following chemotherapy for a malignancy is a multifactorial process that is dependent on the chemotherapeutic agent used, the dosing regimen, and the cumulative dose as well as potential contributing therapies such as radiation and possibly even hematopoietic support from granulocyte colony stimulating factor. In the right combination and in a patient with a conducive milieu of epigenetic factors, leukaemia can develop as a treatment complication. Leukaemia cutis is the specific infiltration of the skin by leukaemic cells and occurs most commonly when the underlying leukaemia is an acute myeloid leukaemia. Although it is well reviewed in the literature as a result of primary leukaemia, leukaemia cutis has only very rarely been reported in association with therapy-induced leukaemia. This article reviews the factors that contribute to therapy-related leukaemia and the development of leukaemia cutis.

Pediatric Aleukemic Leukemia Cutis

“…35,37 Isolated cases have been described in the setting of Philadelphia chromosome-positive biphenotypic leukemias. 23,44,45 Therapy-related leukemias because of topoisomerase II inhibitors tend to present sooner after therapy than those because of alkylating agents and have monocytic differentiation, commonly because of the MLL rearrangement, fitting with our patient's presentation. 36 Otsubo et al 26 reported the development of an acute promyelocytic leukemia after ALC in association with NPM-RARA fusion transcript in a child.…”

Leukaemia cutis in a patient treated for breast cancer

“…In this case the data indicates that the topoisomerase II inhibitor, doxorubicin, is the primary, albeit not sole, culprit agent. The characteristics of her leukaemia best fit the topoisomerase II‐related leukaemia profile 1 . There was a short latency period of 16 months, no preleukaemic phase, and a monocytic (M‐5) subtype AML.…”

“…Leukaemia associated with alkylating agents contrasts with leukaemias due to topoisomerase II inhibitors with respect to onset, presence or absence of a preleukaemic phase, classification, genetic aberrations, and prognosis 1 . These differences have allowed practitioners to determine the potential causative agent.…”

“…For breast cancer, the frequently used chemotherapeutic agents in the alkylating class and the topoisomerase inhibitors have been extensively studied and the leukaemias resulting from these agents have been found to show several important differences in their presentation compared with primary leukaemia. Involvement of the skin with leukaemic cells associated with a therapy‐related leukaemia has only rarely been reported 1 . We present the case of a patient with a history of breast cancer who presented with eruptive cutaneous nodules as the initial manifestation of leukaemia.…”

“…Therapy‐related leukaemia is known to occur following chemotherapy for the treatment of a malignancy 1–4 . For breast cancer, the frequently used chemotherapeutic agents in the alkylating class and the topoisomerase inhibitors have been extensively studied and the leukaemias resulting from these agents have been found to show several important differences in their presentation compared with primary leukaemia.…”