Relapse of ovarian cancer with bone marrow infiltration and concurrent emergence of therapy-related acute myeloid leukemia: a case report.

Case Report A 46-year-old woman was admitted to our hospital because of anemia and thrombocytopenia. Seven years before admission, she was diagnosed with epithelia ovarian cancer (International Federation of Gynecology and Obstetrics stage IIIC) and was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy (suboptimal debulking) followed by six courses of paclitaxel and carboplatin (total dose 1,800 mg and 4,500 mg, respectively), which resulted in a complete clinical response. Three months after chemotherapy she underwent an autologous transplantation using cyclophosphamide (4 g/m) and granulocyte colony-stimulating factors for mobilization and high-dose melphalan (180 mg/m) as conditioning regimen. Until recently, she was without evidence of disease. On admission her peripheral blood count status was as follows: hemoglobin 8 g/dL, WBCs 7.4 10/L (2% blasts, 62% neutrophils, 32% lymphocytes, 4% monocytes), and platelets 81 10/L. A bone marrow aspiration revealed hypercellularity, 20% blasts (Fig 1, black arrows) with Auer bodies and congregations of ovarian cancer cells (large epithelial cells with multiple nuclei and basophilic cytoplasm; Figs 1 and 2, white arrows). Immunophenotyping and flow cytometric analysis revealed that the blasts expressed myeloid antigens CD34, CD33, and CD117. Immunochemistry on trephine biopsy specimen recorded bone marrow infiltration by cells of epithelial origin. Conventional chromosome analysis showed a complex hypodiploid karyotype with monosomy 5, 18, and 21 (44 45, XX, 1, 5, 18, 21, add[21][p11], r, 3mar). CA125 was raised to abnormal levels, whereas chest and abdominal computed tomography scans did not show any lesions. A diagnosis of acute myeloid leukemia (AML; WHO classification) and concurrent ovarian cancer relapse with bone marrow infiltration was made. An AML-oriented chemotherapy with idarubicin (12 mg/m/d for 3 days) and cytarabine (200 mg/m/d for 7 days) was initiated. The disease proved to be refractory to chemotherapy and the patient died 6 months later, despite the administration of high-dose cytarabine (3 g/m for 3 days) as salvage therapy.